Social inequalities in non-small cell lung cancer management and survival: a population-based study in central Sweden
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- 2King's College London, Medical School, London, UK
- 3Karolinska Institutet, Department LIME, Medical Management Centre, R&D unit/Stockholms Sjukhem Foundation, Stockholm, Sweden
- 4Department of Oncology, Uppsala University, Uppsala, Sweden
- 5Department of Surgery, Uppsala University, Uppsala, Sweden
- Correspondence to Mr Anders Berglund, Department of Medical Epidemiology and Biostatistics, Box 281, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Received 2 September 2009
- Accepted 12 January 2010
Objectives To examine possible associations between socioeconomic status, management and survival of patients with non-small cell lung cancer (NSCLC).
Methods In a population-based cohort study, information was retrieved from the Regional Lung Cancer Register in central Sweden, the Cause of Death Register and a social database. ORs and HRs were compared to assess associations between educational level and management and survival.
Results 3370 eligible patients with an NSCLC diagnosis between 1996 and 2004 were identified. There were no differences in stage at diagnosis between educational groups. A higher diagnostic intensity was observed in patients with high compared with low education. There were also social gradients in time between referral and diagnosis in early stage disease (median time: low, 32 days; high, 17 days). Social differences in treatment remained following adjustment for prognostic factors (surgery in early stage disease, high vs low OR 2.84; CI 1.40 to 5.79). Following adjustment for prognostic factors and treatment, the risk of death in early stage disease was lower in women with a high education (high vs low HR 0.33; CI 0.14 to 0.77).
Conclusion The results of this study indicate that socioeconomically disadvantaged groups with NSCLC receive less intensive care. Low education remained an independent predictor of poor survival only in women with early stage disease. The exact underlying mechanisms of these social inequalities are unknown, but differences in access to care, co-morbidity and lifestyle factors may all contribute.
Funding Swedish Council for Working life and Social Research 2006-0587, Swedish Cancer Society Grant 03-0287.
Competing interests None.
Ethics approval This study was conducted with the approval of the Research Ethics Committee at Uppsala University.
Provenance and peer review Not commissioned; externally peer reviewed.