Neighborhood‐level socioeconomic determinants impact outcomes in nonsmall cell lung cancer patients in the Southeastern United States

Abstract

BACKGROUND: Studies examining the impact of lower socioeconomic status (SES) on the outcomes of patients with nonsmall cell lung cancer (NSCLC) are inconsistent. The objective of this study was to clearly elucidate the association between SES, education, and clinical outcomes among patients with NSCLC. METHODS: The study population was derived from a consecutive, retrospective cohort of patients with NSCLC who received treatment within the Duke Health System between 1995 and 2007. SES determinants were based on the individual's census tract and corresponding 2000 Census data. Determinants included the percentage of the population living below poverty, the median household income, and the percentages of residents with at least a high school diploma and at least a bachelor's degree. The SES and educational variables were divided into quartiles. Statistical comparisons were performed using the 25th and 75th percentiles. RESULTS: Individuals who resided in areas with a low median household income or in which a high percentage of residents were living below the poverty line had a shorter cancer-specific 6-year survival than individuals who resided in converse areas (P ¼ .0167 and P ¼ .0067, respectively). Those living in areas in which a higher percentage of residents achieved a high school diploma had improved disease outcomes compared with those living in areas in which a lower percentage attained a high school diploma (P ¼ .0033). A survival advantage also was observed for inhabitants of areas in which a higher percentage of residents attained a bachelor's degree (P ¼ .0455). CONCLUSIONS: Low SES was identified as an independent prognostic factor for poor survival in patients with both early and advanced stage NSCLC. Patients who lived in areas with high poverty levels, low median incomes, and low education levels had worse mortality. Cancer 2012;118:5117-23.

Area Deprivation and Liver Cancer Prevalence in Shenzhen, China: A Spatial Approach Based on Social Indicators

“…The positive coefficient for ADI suggests that greater possibility of liver cancer prevalence would be expected in districts of high social deprivation. It supports prior findings in developed countries that higher cancer prevalence is more likely to occur in highly deprived places (Anne et al 2011;Cramb et al 2012;Erhunmwunsee et al 2012;Hystad et al 2013). For example, area deprivation is associated with lung cancer incidence in Sweden (Li et al 2015) and Canada (Hystad et al 2013).…”

“…The notion ''area'' to define deprivation quantitively is vague and refers to a geographic unit. It can mean ''neighborhood'' (Pearce et al 2007;Erhunmwunsee et al 2012;Brennan-Olsen et al 2015) or ''region'' (Kuznetsov et al 2011;Yuan and Wu 2013;Grintsova et al 2014). And it is usually identified according to administrative division or creating zones with different characteristics.…”

“…Specifically, it is found that low-income individuals have higher cancer incidence, lower survival and worse life quality (Cramb et al 2012;Du et al 2011;Sharpe et al 2012). The inequities in cancer prevalence or survival associated with deprivation are not limited to the extreme ends of individual level (Erhunmwunsee et al 2012). Researchers argue that population within one neighborhood shares similar norms settings, healthcare resources and socioeconomic environment, and consequently they possibly shape a common level of disease risk and health status beyond individual characteristics (Havard et al 2008;Li et al 2015).…”

“…Scholars have established area deprivation index (ADI) in the Japan, New Zealand, Canada, United States, Italy, France, Spain, and Belgium (Bonfim et al 2009;Nolan and Winston 2011;Panczak et al 2012;Robert et al 2012;Sánchez-Cantalejo et al 2008). Pilot studies identify significant relationships between area deprivation and cancer prevalence in the well-developed countries (Erhunmwunsee et al 2012;Meijer et al 2013). However, rather few studies have characterized the potential association between area deprivation and cancer risk in developing countries.…”

The Effects of Residential Segregation and Neighborhood Characteristics on Surgery and Survival in Patients with Early-Stage Non–Small Cell Lung Cancer

“…For instance, living in areas with lower educational attainment was associated with lower odds of receiving surgery and high risk of death for white patients, but not for black patients. Erhunmwunsee and colleagues (54) and Shugarman and colleagues (55) both found that living in areas with low SES was associated with poorer survival outcomes for lung cancer patients. We deconstructed SES into three primary components: economic, educational, and demographic.…”