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Association between age, deprivation and specific comorbid conditions and the receipt of major surgery in patients with non-small cell lung cancer in England: A population-based study
  1. Aurélien Belot1,
  2. Helen Fowler1,
  3. Edmund Njeru Njagi1,
  4. Miguel-Angel Luque-Fernandez1,
  5. Camille Maringe1,
  6. Winnie Magadi1,
  7. Aimilia Exarchakou1,
  8. Manuela Quaresma1,
  9. Adrian Turculet1,
  10. Michael D Peake2,3,4,
  11. Neal Navani5,6,
  12. Bernard Rachet1
  1. 1 Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  2. 2 Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
  3. 3 National Cancer Registration and Analysis Service, Public Health England, London, UK
  4. 4 Centre for Cancer Outcomes, University College London Hospitals, London, UK
  5. 5 UCL Respiratory, University College London, London, UK
  6. 6 Department of Thoracic Medicine, University College London Hospital, London, UK
  1. Correspondence to Dr Aurélien Belot, Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; aurelien.belot{at}


Introduction We investigated socioeconomic disparities and the role of the main prognostic factors in receiving major surgical treatment in patients with lung cancer in England.

Methods Our study comprised 31 351 patients diagnosed with non-small cell lung cancer in England in 2012. Data from the national population-based cancer registry were linked to Hospital Episode Statistics and National Lung Cancer Audit data to obtain information on stage, performance status and comorbidities, and to identify patients receiving major surgical treatment. To describe the association between prognostic factors and surgery, we performed two different analyses: one using multivariable logistic regression and one estimating cause-specific hazards for death and surgery. In both analyses, we used multiple imputation to deal with missing data.

Results We showed strong evidence that the comorbidities ‘congestive heart failure’, ‘cerebrovascular disease’ and ‘chronic obstructive pulmonary disease’ reduced the receipt of surgery in early stage patients. We also observed gender differences and substantial age differences in the receipt of surgery. Despite accounting for sex, age at diagnosis, comorbidities, stage at diagnosis, performance status and indication of having had a PET-CT scan, the socioeconomic differences persisted in both analyses: more deprived people had lower odds and lower rates of receiving surgery in early stage lung cancer.

Discussion Comorbidities play an important role in whether patients undergo surgery, but do not completely explain the socioeconomic difference observed in early stage patients. Future work investigating access to and distance from specialist hospitals, as well as patient perceptions and patient choice in receiving surgery, could help disentangle these persistent socioeconomic inequalities.

  • lung cancer
  • surgical treatment
  • population-based data
  • socioeconomic inequalities
  • comorbidities

Statistics from


  • Contributors AB and BR developed the concept and design of the study. AB, HF, M-AL-F, CM, WM and AT were involved in the data preparation and the data linkage. AB carried out the data analysis and wrote the manuscript. All authors interpreted the data, drafted and critically revised the manuscript. All authors read and approved the final version of the manuscript.

  • Funding This research was supported by Cancer Research UK (grant number C7923/A18525).

  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the views of Cancer Research UK.

  • Competing interests None declared.

  • Ethics approval The authors have obtained the ethical and statutory approvals required for this research (PIAG 1-05(c)/2007; ECC 1-05(a)/2010); ethical approval updated 6 April 2017 (REC 13/LO/0610).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note The authors attest that they have obtained appropriate permissions and paid any required fees for use of copyright protected materials.

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