Title

Social Determinants of Non-Small Cell Lung Cancer Stage at Diagnosis and Survival in Nebraska

Document Type

Article

Abstract

Abstract: Background: Lung cancer is one of the leading cancers in both incidence and mortality in Nebraska. We investigated how social determinants were associated with the stage at diagnosis and survival time for Nebraska non-small cell lung cancer patients. Methods: A total of 12,821 NSCLC cases diagnosed between 1995 and the end of 2012 were identified using the Nebraska Cancer Registry database linked with the census tract poverty level. General logistic regression model was used to analyze the relationship between social factors and stage at diagnosis, and Cox proportional hazard model was used to investigate the adjusted effect of social factors on lung cancer survival. Results: Among 12,821 lung cancer patients, 2,954 (23.04%) were diagnosed in situ or at localized stages and 9,867 (76.96%) were diagnosed at more advanced stages. Male gender, younger age, Hispanic origin, rural residency and being single were associated with increased ORs of being diagnosed at advanced stages. In survival analysis, patients being single at the time of diagnosis were related with 1.23 time's greater hazard of death, compared to patients who were married. The adjusted hazard ratio was also associated with the type of insurance used (p < 0.0001). Conclusions: Both stage at diagnosis and survival time for NSCLC were associated with different social determinants. Health care providers should provide more emphasis on educating minority populations, patients living alone, and patients with limited insurance coverage about early diagnosis and follow-up care of lung cancer.