Introduction Socioeconomic disparities have been linked to survival differences in patients with lung cancer. Swedish healthcare is tax-funded and provides equal access to care, therefore, survival following lung cancer surgery should be unrelated to household income. The aim of this study was to investigate the association between household disposable income and survival following surgery for lung cancer in Sweden.
Methods We conducted a nationwide population-based cohort study including all patients who underwent pulmonary resections for lung cancer in Sweden 2008–2017. Individual-level record linkages between national quality and health-data registers were performed to acquire information regarding socioeconomic status and medical history. Cox regression by quintiles of household disposable income was used to estimate the adjusted risk for all-cause mortality.
Results We included 5500 patients and the age-adjusted and sex-adjusted incidence rate of death per 100 person-years was 15 and 9.4 in the lowest and highest income quintile, respectively (mean follow-up time 3.2 years). Deprived patients were older, had more comorbidities and were less likely to have preoperative positron emission tomography or minimally invasive surgery, compared with patients with higher income. The adjusted HR for death was 0.77 (95% CI: 0.62 to 0.96) for the highest income quintile compared with the lowest.
Conclusions We found an association between household disposable income and survival in patients who underwent surgery for lung cancer in Sweden, despite tax-funded universal health coverage. The association remained after adjustment for differences in baseline characteristics.
- lung cancer
- non-small cell lung cancer
- thoracic surgery
- clinical epidemiology
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VJ and US contributed equally.
Contributors VJ and US equally contributed to all aspects of this work. All authors contributed to the preparation and approved the final version of the manuscript.
Funding This work was supported by the Swedish Heart-Lung Foundation (grant numbers 20160522, 20160525 and 20180400 to US), Åke Wiberg Foundation (grant number M18-0016 to US), Karolinska Institutet Foundations and Funds (grant numbers 2018-01784 to US and 2018-01530 to VJ), the regional ALF agreement between Region Stockholm and Karolinska Institutet (grant number 20180114 to US).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This study was granted ethical approval by the Swedish Ethical Review Authority and the need for informed consent was waived (registration number: 2017/1435-31).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.
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