Socioeconomic Disparities in Lung Cancer Treatment and Outcomes Persist Within a Single Academic Medical Center

BackgroundSocioeconomic disparities in treatment and outcomes of non–small-cell lung cancer (NSCLC) are well established. To explore whether these differences are secondary to individual or institutional characteristics, we examined treatment selection and outcome in a diverse population treated at a single medical center.Patients and MethodsWe performed a retrospective analysis of consecutive patients diagnosed with NSCLC stages I-III from 2000 to 2005 at the University of Texas Southwestern Medical Center. Treatment selection was dichotomized as ‘standard’ (surgery for stage I-II; surgery and/or radiation therapy for stage III) or ‘other.’ Associations between patient characteristics (including socioeconomic status) and treatment selection were examined using logistic regression; associations between characteristics and overall survival were examined using Cox regression models and Kaplan-Meier survival analysis.ResultsA total of 450 patients were included. Twenty-eight percent of patients had private insurance, 43% had Medicare, and 29% had an indigent care plan. The likelihood of receiving ‘standard’ therapy was significantly associated with insurance type (indigent plan versus private insurance odds ratio [OR] 0.13, 95% confidence interval [CI] 0.04, 0.43 for stage I-II; OR 0.38, 95% CI 0.14, 1.00 for stage III). For patients with stage I-II NSCLC, survival was associated with age, sex, insurance type (indigent plan versus private insurance hazard ratio for death 1.98; 95% CI 1.16, 3.37), stage, and treatment selection. In stage III NSCLC, survival was associated with treatment selection.ConclusionWithin a single academic medical center, socioeconomically disadvantaged patients with stage I-III NSCLC are less likely to receive ‘standard’ therapy. Socioeconomically disadvantaged patients with stage I-II NSCLC have inferior survival independent of therapy.