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Socioeconomic position and delays in lung cancer diagnosis: should we target the more deprived?
  1. David R Baldwin
  1. Correspondence to Dr David R Baldwin, Respiratory Medicine Unit, Nottingham University Hospitals and University of Nottingham, David Evans Centre, Nottingham City Hospital Campus, Nottingham NG5 1PB, UK; David.baldwin{at}

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Lung cancer incidence and mortality increase with all measures of socioeconomic deprivation primarily because of the fact that smoking rates also increase with the same measures. This powerful association means that we see double the number of people with lung cancer in the most deprived quintile compared with the least deprived. Socioeconomic deprivation is associated with reduced survival, more early deaths (within 30 or 90 days) and lower treatment rates.1–3 Possible explanations include a failure to present and seek help from doctors early and less effective primary healthcare in deprived communities, both factors postulated to result in delays in diagnosis and later stage at presentation. The systematic review and meta-analysis by Forrest et al4 concludes that there is no association between socioeconomic position (SEP) and either stage at diagnosis or time intervals on the lung cancer pathway. More deprived patients were more likely to present as emergencies. The most important limitation, acknowledged by the authors, is the potential for masking of the effect of SEP on delays in the pathway by the ‘sicker quicker’ effect. This refers to the finding that sicker patients progress more quickly through the pathway, thus potentially cancelling an effect of SEP on late presentation. This factor was not accounted for in the included studies. They also raise concerns about whether all studies that contain information about the factors studied have been included. Despite these important limitations, the authors say that the implication of their findings for policy is that early diagnosis campaigns do not need to be targeted to the more deprived and that these should be applied irrespective of SEP. Back-tracking somewhat, they also say it may be prudent to target the more deprived groups purely because of the increased incidence of lung cancer. So, do we target the more deprived or not? …

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