Socioeconomic Inequalities in Lung Cancer Treatment: Systematic Review and Meta-Analysis
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BACKGROUND: Intervention-generated inequalities are unintended variations in outcome that result from the organisation and delivery of health interventions. Socioeconomic inequalities in treatment may occur for some common cancers. Although the incidence and outcome of lung cancer varies with socioeconomic position (SEP), it is not known whether socioeconomic inequalities in treatment occur and how these might affect mortality. We conducted a systematic review and meta-analysis of existing research on socioeconomic inequalities in receipt of treatment for lung cancer. METHODS AND FINDINGS: MEDLINE, EMBASE, and Scopus were searched up to September 2012 for cohort studies of participants with a primary diagnosis of lung cancer (ICD10 C33 or C34), where the outcome was receipt of treatment (rates or odds of receiving treatment) and where the outcome was reported by a measure of SEP. Forty-six papers met the inclusion criteria, and 23 of these papers were included in meta-analysis. Socioeconomic inequalities in receipt of lung cancer treatment were observed. Lower SEP was associated with a reduced likelihood of receiving any treatment (odds ratio [OR] = 0.79 [95% CI 0.73 to 0.86], p<0.001), surgery (OR = 0.68 [CI 0.63 to 0.75], p<0.001) and chemotherapy (OR = 0.82 [95% CI 0.72 to 0.93], p = 0.003), but not radiotherapy (OR = 0.99 [95% CI 0.86 to 1.14], p = 0.89), for lung cancer. The association remained when stage was taken into account for receipt of surgery, and was found in both universal and non-universal health care systems. CONCLUSIONS: Patients with lung cancer living in more socioeconomically deprived circumstances are less likely to receive any type of treatment, surgery, and chemotherapy. These inequalities cannot be accounted for by socioeconomic differences in stage at presentation or by differences in health care system. Further investigation is required to determine the patient, tumour, clinician, and system factors that may contribute to socioeconomic inequalities in receipt of lung cancer treatment.
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Disparities in race, sex, socioeconomic status, level of education, residence, and insurance status, among other factors, continue to be associated with outcomes such as mortality, incidence, stage at diagnosis, and timely receipt of recommended treatment for patients with NSCLC.
“The results show that disparities in race,128–131 sex,132 socioeconomic status,132–135 level of education,136 residence,128,136 and insurance status,137–139 among other factors, continue to be associated with outcomes such as mortality,128,140 incidence,137,140 stage at diagnosis, and timely receipt of recommended treatment129,131 for patients with NSCLC.”
From Systemic Therapy for Stage IV Non–Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update (2015) · cites this paper as [129]
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- Authors
- Forrest, L. F., Adams, J., Wareham, H., Rubin, G., & White, M.
- Affiliations
- Newcastle University (GB)
- Durham University (GB)
- Corresponding author
- Forrest, Lynne F.
- Venue
- PLoS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2013-02-05
- Volume
- 10
- Issue
- 2
- Pages
- e1001376
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC3564770
- OpenAlex
- W2147340827
- Cited by
- 220
- References
- 78
- Citations by year
- 2026: 15 · 2025: 20 · 2024: 18 · 2023: 20 · 2022: 13 · 2021: 20 · 2020: 19 · 2019: 20 · 2018: 15 · 2017: 11 · 2016: 12 · 2015: 22 · 2014: 12 · 2013: 3
- FWCI
- 2.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Durham Research Online (Durham University) (acceptedVersion, other-oa)
- Durham Research Online (Durham University) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Newcastle University ePrints (Newcastle Univesity)
- Newcastle University ePrints (Newcastle Univesity) (cc-by)
- Funders
- United Kingdom Clinical Research Collaboration
- Cancer Research UK
- National Institute for Health and Care Research
- British Heart Foundation
- Medical Research Council (MR/K02325X/1)
- Economic and Social Research Council (ES/G007470/1)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- lung cancer, socioeconomic disparities, health disparities, treatment receipt, socioeconomic position, chemotherapy, radiotherapy, health care access, universal health care, cancer mortality
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Health Services Accessibility, Humans, Infant, Infant, Newborn, Lung Neoplasms, Male, Middle Aged, Outcome and Process Assessment, Health Care, Risk Factors, Socioeconomic Factors, Odds Ratio, Treatment Outcome, Risk Assessment, Healthcare Disparities, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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