Sociodemographic survival disparities for lung cancer in the United States, 2000–2016
Menée à partir des données 2000–2016 des registres américains des cancers portant sur 557 555 patients atteints d'un cancer du poumon, cette étude analyse les disparités sociodémographiques dans la survie
Background : Understanding the impact of patient and tumor characteristics on lung cancer survival can help to build personalized prognostic models and identify health disparities. Methods : We identified 557,555 patients aged 25+ years diagnosed with lung/bronchus carcinoma from the SEER database, 2000–2016. We estimated hazard ratios (HR) for demographic (sex, age, race and ethnicity), tumor (stage, histology, year of diagnosis), and geographic characteristics (census-tract-level urbanicity, socioeconomic status (SES)), as well as selected interactions, on the rate of lung-cancer-specific death using multivariable proportional hazards models. Results : Females had a higher survival (lower hazard) of lung-cancer-specific death than males (HR 0.83, 95% CI: 0.82, 0.83). Hazards differed by race and ethnicity. Regional (HR: 2.41, 95% CI: 2.37, 2.44) and distant (HR: 6.61, 95% CI: 6.53, 6.69) tumors were associated with a lower survival (higher hazard) than localized tumors. Small-cell tumors were associated with a lower survival (HR 1.19, 95% CI: 1.18, 1.20) than non-small-cell tumors. Patients diagnosed after 2009 had lower hazards (HR 0.86, 95% CI: 085, 0.86) than those diagnosed 2000–2009. Lung-cancer-specific survival did not depend on urbanicity after adjusting for census-tract-level SES, but survival decreased with decreasing census-tract-level SES. Differences in survival between non-Hispanic Black and White patients were greater for younger patients and localized tumors and increased with census-tract-level SES. Differences by sex were greatest for young patients and localized tumors. Conclusions : Disparities in survival after lung cancer diagnosis remain, with intersectional patterns suggesting differential access to and quality of care. Efforts are needed to ensure high-risk groups receive guideline-concordant treatment.