Dalton Susanne O, Steding-Jessen Marianne, Jakobsen Erik, Mellemgaard Anders, Østerlind Kell, Schüz Joachim, Johansen Christoffer
Danish Cancer Society Research Centre , Copenhagen , Denmark.
Acta Oncol. 2015 May;54(5):797-804. doi: 10.3109/0284186X.2014.1001037. Epub 2015 Mar 12.
To address social inequality in survival after lung cancer, it is important to consider how socioeconomic position (SEP) influences prognosis. We investigated whether SEP influenced receipt of first-line treatment and whether socioeconomic differences in survival could be explained by differences in stage, treatment and comorbidity.
In the Danish Lung Cancer Register, we identified 13 045 patients with lung cancer diagnosed in 2004-2010, with information on stage, histology, performance status and first-line treatment. We obtained age, gender, vital status, comorbid conditions and socioeconomic information (education, income and cohabitation status) from nationwide population-based registers. Associations between SEP and receipt of first-line treatment were analysed in multivariate logistic regression models and those with overall mortality in Cox regression models with stepwise inclusion of possible mediators.
For both low- and high-stage lung cancer, adjusted ORs for first-line treatment were reduced in patients with short education and low income, although the OR for education did not reach statistical significance in men with high-stage disease. Patients with high-stage disease who lived alone were less likely to receive first-line treatment. The socioeconomic difference in overall survival was partly explained by differences in stage, treatment and comorbidity, although some differences remained after adjustment. Among patients with high-stage disease, the hazard ratio (HR) for death of those with low income was 1.12 (95% CI 1.05-1.19) in comparison with those with high income. Among patients with low-stage disease, those who lived alone had a 14% higher risk for dying (95% CI 1.05-1.25) than those who lived with a partner. The differences in risk for death by SEP were greatest in the first six months after diagnosis.
Socioeconomic differences in survival after lung cancer are partly explained by social inequality in stage, first-line treatment and comorbidity. Efforts should be made to improve early diagnosis and adherence to first-line treatment recommendations among disadvantaged lung cancer patients.
为解决肺癌患者生存方面的社会不平等问题，考虑社会经济地位（SEP）如何影响预后很重要。我们调查了SEP是否影响一线治疗的接受情况，以及生存方面的社会经济差异是否可以通过分期、治疗和合并症的差异来解释。
在丹麦肺癌登记处，我们识别出2004年至2010年诊断出的13045例肺癌患者，他们有关于分期、组织学、体能状态和一线治疗的信息。我们从全国基于人群的登记处获取了年龄、性别、生命状态、合并症情况以及社会经济信息（教育程度、收入和同居状态）。在多变量逻辑回归模型中分析SEP与一线治疗接受情况之间的关联，在逐步纳入可能的中介因素的Cox回归模型中分析SEP与总死亡率之间的关联。
对于低分期和高分期肺癌患者，教育程度低和收入低的患者接受一线治疗的校正比值比均降低，尽管在高分期疾病男性患者中教育程度的比值比未达到统计学显著性。独自生活的高分期疾病患者接受一线治疗的可能性较小。总生存方面的社会经济差异部分可通过分期、治疗和合并症的差异来解释，尽管调整后仍存在一些差异。在高分期疾病患者中，低收入患者的死亡风险比（HR）为1.12（95%可信区间1.05 - 1.19），而高收入患者为1。在低分期疾病患者中，独自生活的患者死亡风险比与有伴侣生活的患者相比高14%（95%可信区间1.05 - 1.25）。SEP导致的死亡风险差异在诊断后的前六个月最大。
肺癌患者生存方面的社会经济差异部分可通过分期、一线治疗和合并症方面的社会不平等来解释。应努力改善处境不利的肺癌患者的早期诊断和对一线治疗建议的依从性。
