Socioeconomic position and survival after lung cancer: Influence of stage, treatment and comorbidity among Danish patients with lung cancer diagnosed in 2004-2010
Socioeconomic position and survival after lung cancer: Influence of stage, treatment and comorbidity among Danish patients with lung cancer diagnosed in 2004-2010
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DOI：
10.3109/0284186x.2014.1001037
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发表时间：
2015-05-01
期刊：
影响因子：
3.1
通讯作者：
Johansen, Christoffer
中科院分区：
文献类型：
--
作者：
Dalton, Susanne O.;Steding-Jesen, Marianne;Johansen, Christoffer
背景为了解决肺癌后生存的社会不平等问题，重要的是要考虑社会经济地位（SEP）如何影响预后。我们调查了SEP是否影响一线治疗的接受，以及生存的社会经济学差异是否可以通过分期、治疗和合并症的差异来解释。在丹麦肺癌登记中，我们确定了2004-2010年诊断的13045例肺癌患者，包括分期、组织学、体能状态和一线治疗信息。我们从全国人口登记处获得了年龄，性别，生命状态，共病状况和社会经济信息（教育，收入和同居状况）。SEP与一线治疗的相关性采用多变量logistic回归模型进行分析，SEP与总死亡率的相关性采用逐步纳入可能的中介因素的考克斯回归模型进行分析。对于低、高分期肺癌，受教育时间短、收入低的患者一线治疗的校正OR值均降低，尽管高分期男性受教育程度的OR值未达到统计学显著性。独居的高分期患者接受一线治疗的可能性较小。总生存率的社会经济学差异部分由分期、治疗和合并症的差异解释，尽管调整后仍存在一些差异。在高分期患者中，低收入者与高收入者相比死亡的风险比（HR）为1.12（95%CI 1.05-1.19）。在低阶段疾病患者中，独居者的死亡风险比与伴侣生活的患者高14%（95%CI 1.05-1.25）。SEP的死亡风险差异在诊断后的前6个月最大。肺癌患者生存率的社会经济差异部分可以通过分期、一线治疗和合并症方面的社会不平等来解释。应努力改善弱势肺癌患者的早期诊断和一线治疗建议的依从性。
Background. 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.Material and methods. 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.Results. 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.Conclusion. 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.