Division of General Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27707, USA.
Cancer. 2012 Oct 15;118(20):5117-23. doi: 10.1002/cncr.26185. Epub 2012 Mar 5.
Studies examining the impact of lower socioeconomic status (SES) on the outcomes of patients with nonsmall cell lung cancer (NSCLC) are inconsistent. The objective of this study was to clearly elucidate the association between SES, education, and clinical outcomes among patients with NSCLC.
The study population was derived from a consecutive, retrospective cohort of patients with NSCLC who received treatment within the Duke Health System between 1995 and 2007. SES determinants were based on the individual's census tract and corresponding 2000 Census data. Determinants included the percentage of the population living below poverty, the median household income, and the percentages of residents with at least a high school diploma and at least a bachelor's degree. The SES and educational variables were divided into quartiles. Statistical comparisons were performed using the 25th and 75th percentiles.
Individuals who resided in areas with a low median household income or in which a high percentage of residents were living below the poverty line had a shorter cancer-specific 6-year survival than individuals who resided in converse areas (P = .0167 and P = .0067, respectively). Those living in areas in which a higher percentage of residents achieved a high school diploma had improved disease outcomes compared with those living in areas in which a lower percentage attained a high school diploma (P = .0033). A survival advantage also was observed for inhabitants of areas in which a higher percentage of residents attained a bachelor's degree (P = .0455).
Low SES was identified as an independent prognostic factor for poor survival in patients with both early and advanced stage NSCLC. Patients who lived in areas with high poverty levels, low median incomes, and low education levels had worse mortality.
研究表明，较低的社会经济地位（SES）对非小细胞肺癌（NSCLC）患者的预后有影响，但研究结果并不一致。本研究旨在明确 SES、教育程度与 NSCLC 患者临床结局之间的相关性。
本研究的研究人群来自于 1995 年至 2007 年期间在杜克健康系统接受治疗的连续回顾性 NSCLC 患者队列。SES 决定因素基于个体的普查区和相应的 2000 年人口普查数据。决定因素包括生活在贫困线以下的人口百分比、家庭中位数收入以及至少具有高中文凭和至少学士学位的居民百分比。SES 和教育变量分为四分位数。使用第 25 和 75 百分位数进行统计比较。
与居住在中位数家庭收入较高或居民中贫困人口比例较低地区的个体相比，居住在中位数家庭收入较低或居民中贫困人口比例较高地区的个体癌症特异性 6 年生存率较短（P=0.0167 和 P=0.0067）。与居住在高中文凭比例较低地区的个体相比，居住在高中文凭比例较高地区的个体疾病结局更好（P=0.0033）。居住在拥有更高比例学士学位居民的地区的居民也观察到生存优势（P=0.0455）。
低 SES 被确定为早期和晚期 NSCLC 患者生存不良的独立预后因素。生活在贫困水平高、中位数收入低和教育水平低的地区的患者死亡率更高。
