Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK Wolfson Research Institute, Durham University, Queen's Campus, Stockton on Tees, UK.
Thorax. 2015 Feb;70(2):138-45. doi: 10.1136/thoraxjnl-2014-205517. Epub 2014 Jun 12.
Lung cancer survival is socioeconomically patterned, and socioeconomic inequalities in receipt of treatment have been demonstrated. In England, there are target waiting times for the referral (14 days) and treatment intervals (31 days from diagnosis, 62 days from GP referral). Socioeconomic inequalities in the time intervals from GP referral have been found. Cancer registry, Hospital Episode Statistics and lung cancer audit data were linked in order to investigate the contribution of these inequalities to socioeconomic inequalities in lung cancer survival.
Logistic regression was used to examine the likelihood of being alive 2 years after diagnosis, by socioeconomic position, for 22,967 lung cancer patients diagnosed in 2006-2009, and in a subset with stage recorded (n=5233).
Socioeconomic inequalities in survival were found in a multivariable analysis adjusted for age, sex, histology, year, timely GP referral, performance status and comorbidity, with those in the most deprived socioeconomic group significantly less likely to be alive after 2 years (OR=0.77, 95% CI 0.66 to 0.88, p<0.001). When receipt of treatment was included in the analysis, the association no longer remained significant (OR=0.87, 95% CI 0.75 to 1.00, p=0.06). Addition of timeliness of treatment did not alter the conclusion. Patients treated within guideline targets had lower likelihood of two-year survival.
Socioeconomic inequalities in survival from lung cancer were statistically explained by socioeconomic inequalities in receipt of treatment, but not by timeliness of referral and treatment. Further research is required to determine the currently unexplained socioeconomic variance in treatment rates.
肺癌的生存状况存在社会经济模式，并且已经证明了在治疗方面存在社会经济不平等。在英国，有转诊的目标等待时间（14 天）和治疗间隔（从诊断起 31 天，从全科医生转诊起 62 天）。已经发现了从全科医生转诊到治疗的时间间隔存在社会经济不平等。为了调查这些不平等现象对肺癌生存的社会经济不平等现象的贡献，对癌症登记处、医院入院统计数据和肺癌审计数据进行了关联。
使用逻辑回归来检查 2006-2009 年诊断的 22967 例肺癌患者和记录分期的患者亚组（n=5233）的社会经济地位与 2 年后存活的可能性。
在多变量分析中，对年龄、性别、组织学、年份、及时的全科医生转诊、表现状态和合并症进行了调整，发现最贫困的社会经济群体在 2 年后存活的可能性显著降低（OR=0.77，95%CI 0.66 至 0.88，p<0.001）。当将治疗的接受情况纳入分析时，这种关联不再具有统计学意义（OR=0.87，95%CI 0.75 至 1.00，p=0.06）。添加治疗的及时性并没有改变结论。在指南目标内接受治疗的患者两年生存率较低。
肺癌生存的社会经济不平等现象在统计学上可以通过治疗的社会经济不平等来解释，但不能通过转诊和治疗的及时性来解释。需要进一步研究以确定目前尚未解释的治疗率的社会经济差异。
