Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Cancer Med. 2020 May;9(10):3407-3416. doi: 10.1002/cam4.2978. Epub 2020 Mar 20.
Socioeconomic status (SES) has led to treatment and survival disparities; however, limited data exist for non-small cell lung cancer (NSCLC). This study investigates the impact of SES on NSCLC diagnostic imaging, treatment, and overall survival (OS), and describes temporal disparity trends. The Ontario Cancer Registry was used to identify NSCLC patients diagnosed between 2007 and 2016. Through linkage to administrative datasets, patients' demographics, imaging, treatment, and survival were obtained. Based on median household neighborhood income, the Ontario population was divided into five income quintiles (Q1-Q5; Q1 = lowest income). Multivariable regressions assessed SES association with OS, imaging, treatment receipt, and treatment delay, and their interaction with year of diagnosis to understand temporal trends. Endpoints were adjusted for demographics, stage and comorbidities, along with treatments and imaging for OS. A total of 50 542 patients were identified. Higher SES patients (Q5 vs. Q1) showed improved 5-year OS (hazard ratio, 0.89; 95% confidence interval [CI], 0.87-0.92; P < .0001) and underwent greater magnetic resonance imaging head (stages IA-IV; odds ratio [OR], 1.24; 95% CI, 1.16-1.32; P < .0001), lung resection (IA-IIIA; OR, 1.58; 95% CI, 1.43-1.74; P < .0001), platinum-based vinorelbine adjuvant chemotherapy (IB-IIIA; OR, 1.63; 95% CI, 1.39-1.92; P < .0001), palliative radiation (IV; OR, 1.14; 95% CI, 1.05-1.25; P = .023), and intravenous chemotherapy (IV; OR, 1.45; 95% CI, 1.32-1.60; P < .0001). Lower SES patients underwent greater thoracic radiation (IA-IIIB; OR, 0.86; 95% CI, 0.79-0.94; P = .0003). Across 2007-2016, socioeconomic disparities remain largely unchanged (interaction P > .05) despite widening income inequality.
社会经济地位（SES）导致了治疗和生存方面的差异；然而，针对非小细胞肺癌（NSCLC）的相关数据有限。本研究旨在调查 SES 对 NSCLC 诊断性影像学检查、治疗和总生存期（OS）的影响，并描述了时间差异趋势。研究人员使用安大略省癌症登记处（Ontario Cancer Registry）的数据，确定了 2007 年至 2016 年间诊断为 NSCLC 的患者。通过与行政数据集的链接，获取了患者的人口统计学、影像学、治疗和生存情况。根据家庭中位数社区收入，将安大略省人群分为五个收入五分位数（Q1-Q5；Q1 表示最低收入）。多变量回归评估了 SES 与 OS、影像学检查、治疗获得情况和治疗延迟的相关性，并分析了它们与诊断年份的相互作用，以了解时间趋势。终点通过调整人口统计学、分期和合并症，以及 OS 的治疗和影像学情况进行调整。共确定了 50542 名患者。SES 较高的患者（Q5 与 Q1 相比）显示出改善的 5 年 OS（风险比，0.89；95%置信区间 [CI]，0.87-0.92；P <.0001），并接受了更多的磁共振成像头部（IA-IV 期；优势比 [OR]，1.24；95%CI，1.16-1.32；P <.0001）、肺切除术（IA-IIIA 期；OR，1.58；95%CI，1.43-1.74；P <.0001）、含铂依托泊苷辅助化疗（IB-IIIA 期；OR，1.63；95%CI，1.39-1.92；P <.0001）、姑息性放疗（IV 期；OR，1.14；95%CI，1.05-1.25；P = 0.023）和静脉化疗（IV 期；OR，1.45；95%CI，1.32-1.60；P <.0001）。SES 较低的患者接受了更多的胸部放疗（IA-IIIB 期；OR，0.86；95%CI，0.79-0.94；P = 0.0003）。尽管收入不平等不断扩大，但 2007-2016 年间，社会经济差距基本保持不变（交互 P > 0.05）。
