Household disposable income and long-term survival after pulmonary resections for lung cancer

Abstract

IntroductionSocioeconomic disparities have been linked to survival differences in patients with lung cancer. Swedish healthcare is tax-funded and provides equal access to care, therefore, survival following lung cancer surgery should be unrelated to household income. The aim of this study was to investigate the association between household disposable income and survival following surgery for lung cancer in Sweden.MethodsWe conducted a nationwide population-based cohort study including all patients who underwent pulmonary resections for lung cancer in Sweden 2008–2017. Individual-level record linkages between national quality and health-data registers were performed to acquire information regarding socioeconomic status and medical history. Cox regression by quintiles of household disposable income was used to estimate the adjusted risk for all-cause mortality.ResultsWe included 5500 patients and the age-adjusted and sex-adjusted incidence rate of death per 100 person-years was 15 and 9.4 in the lowest and highest income quintile, respectively (mean follow-up time 3.2 years). Deprived patients were older, had more comorbidities and were less likely to have preoperative positron emission tomography or minimally invasive surgery, compared with patients with higher income. The adjusted HR for death was 0.77 (95% CI: 0.62 to 0.96) for the highest income quintile compared with the lowest.ConclusionsWe found an association between household disposable income and survival in patients who underwent surgery for lung cancer in Sweden, despite tax-funded universal health coverage. The association remained after adjustment for differences in baseline characteristics.

Sex and Survival After Surgery for Lung Cancer

“…Socioeconomic disparities have been shown to influence lung cancer survival. [44][45][46] Women in this cohort achieved a higher educational level than men, which has been linked to a better prognosis. 46 However, women had lower incomes and more often lived alone, factors that have been associated with poorer survival.…”

“… 46 However, women had lower incomes and more often lived alone, factors that have been associated with poorer survival. 44 , 45 Socioeconomic status also has been linked to lifestyle behaviors such as alcohol consumption. 47 , 48 In Sweden, excessive alcohol consumption has been found to be higher among those with an intermediate level of education as compared with those with the highest or the lowest educational levels.…”

Prognosis and Survival Analysis of 922,317 Lung Cancer Patients from the US Based on the Most Recent Data from the SEER Database (April 15, 2021)

“…Median survival time was longer for patients with higher incomes and there was also an association between family disposable income and survival. 27 Low-income patients with lung cancer may have delays in diagnosis and treatment, requiring social intervention and care. 28 Increased healthcare costs in the public sector were associated with lower cancer mortality.…”

Small-area data on socioeconomic status and immigrant groups for evaluating equity of early cancer detection and care

“…As a more appropriate direct measure of SES, investigators may consider disposable income per household (standardised by taking into account household composition) [16]. For example, in a recent Swedish study addressing the association between SES and survival following surgery for lung cancer, SES was assessed by assigning household disposable income to each patient and categorising the patients into income quintiles [17].…”