Treatment and survival disparities in lung cancer: The effect of social environment and place of residence

Johnson, Asal M.; Hines, Rebecca; Johnson, James Allen; Bayakly, A. Rana

doi:10.1016/j.lungcan.2014.01.008

Cited by 115 publications

(126 citation statements)

References 39 publications

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“…Our findings therefore support calls for urgent action to address socioeconomic disparity in treatment7 10 24 35 and survival of patients with lung cancer 8–11 24…”

Section: Discussionsupporting

confidence: 74%

“…There is mixed evidence of urban–rural survival differences in the literature 7–9 11 15–19. While it did not show a statistically significant relationship between area of residence of survival for all cases, a study in the US state of Georgia found that among early-stage patients with non-small cell lung cancer, those in rural areas had a higher survival rate than urban patients 7. A study in Denmark found that those in peripheral rural areas, which was the most remote category, had higher survival than those in urban areas or rural areas 19.…”

Section: Discussionmentioning

confidence: 92%

“…Living far from treatment facilities has been associated with lower surgery rates, even controlling for area-level deprivation13 or patient financial status 14. However, the literature on survival is mixed: while some find a rural disadvantage,9 15–17 others report no difference by area of residence,8 11 18 or a qualified rural advantage 7 19. The present study is the first to address urban/rural differences in lung cancer outcomes in Ireland, which has a distinctively high rural population (37%) compared with other countries in the World Bank High Income category (average 19%) 20…”

Section: Introductionmentioning

confidence: 99%

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Urban–rural differences in cancer-directed surgery and survival of patients with non-small cell lung cancer

Thomas

Pearce

O’Neill

et al. 2016

J Epidemiol Community Health

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“…Our findings therefore support calls for urgent action to address socioeconomic disparity in treatment7 10 24 35 and survival of patients with lung cancer 8–11 24…”

Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Urban–rural differences in cancer-directed surgery and survival of patients with non-small cell lung cancer

Thomas

Pearce

O’Neill

et al. 2016

J Epidemiol Community Health

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“…Communities with economic and political resources are better equipped to influence zoning regulations, ensure employment and educational opportunities, and make successful attempts to avoid noxious facilities (14,53) Few studies have examined the association of area-level characteristics with the receipt of treatment or survival for NSCLC patients in the United States. In an earlier study (22) of all NSCLC patients (all stages) we found educational attainment and economic deprivation were associated with receipt of surgery and survival outcomes. Our current study suggests similar associations; although, the characteristics that were meaningful differed for black and white patients.…”

Section: Cancer Epidemiol Biomarkers Prev; 25(5) May 2016mentioning

confidence: 82%

“…17). Although the negative effects of lower SES on NSCLC treatment and survival have been widely studied (18)(19)(20)(21)(22), the impact of residential segregation on prognosis and the utilization of cancer care have yet to be determined. The only study to date investigating the relationship between segregation and lung cancer found black and Hispanic patients living in highly segregated areas had lower odds of early-stage diagnosis compared with white patients (16).…”

Section: Introductionmentioning

confidence: 99%

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

Johnson

Hines

et al. 2016

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Although the negative effects of lower socioeconomic status on non-small cell lung cancer (NSCLC) treatment and survival have been widely studied, the impact of residential segregation on prognosis and the receipt of treatment has yet to be determined.Methods: This is a retrospective, cohort study of NSCLC patients in Georgia (2000-2009; n ¼ 8,322) using data from the Georgia Comprehensive Cancer Registry. The effects of segregation, economic deprivation, and combined segregation/deprivation on the odds of receiving surgery were examined in separate multilevel models. To determine the association for the exposures of interest on the risk of death for different racial groups, separate multilevel survival models were conducted for black and white patients.Results: Living in areas with the highest [AOR ¼ 0.35, 95% confidence interval (CI), 0.19-0.64] and second highest

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Socioeconomic Deprivation and Health Care Use in Patients Enrolled in SWOG Cancer Clinical Trials

Hershman,

Vaidya,

Till

et al. 2024

JAMA Netw Open

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ImportanceReducing acute care use is an important strategy for improving value. Patients with cancer are at risk for unplanned emergency department (ED) visits and hospital stays (HS). Clinical trial patients have homogeneous treatment; despite this, structural barriers to care may independently impact acute care use.ObjectiveTo examine whether ED visits and HS within 12 months of trial enrollment are more common among Medicare enrollees who live in areas of socioeconomic deprivation or have Medicaid insurance.Design, Setting, and ParticipantsThis cohort study included patients with cancer who were 65 years or older and treated in SWOG Cancer Research Network trials from 1999 to 2018 using data linked to Medicare claims. Data were collected from 1999 to 2019 and analyzed from 2022 to 2024.Main Outcomes and MeasuresOutcomes were ED visits, HS, and costs in the first year following enrollment. Neighborhood socioeconomic deprivation was measured using patients’ zip code linked to the Area Deprivation Index (ADI), measured on a 0 to 100 scale for increasing deprivation and categorized into tertiles (T1 to T3). Type of insurance was classified as Medicare with or without commercial insurance vs dual Medicare and Medicaid. Demographic, clinical, and prognostic factors were captured from trial records. Multivariable regression was used, and the association of ADI and insurance with each outcome was considered separately.ResultsIn total, 3027 trial participants were analyzed. The median (range) age was 71 (65-98) years, 1280 (32.3%) were female, 221 (7.3%) were Black patients, 2717 (89.8%) were White patients, 90 (3.0%) had Medicare and Medicaid insurance, and 660 (22.3%) were in the areas of highest deprivation (ADI-T3). In all, 1094 patients (36.1%) had an ED visit and 983 patients (32.4%) had an HS. In multivariable generalized estimating equation, patients living in areas categorized as ADI-T3 were more likely to have an ED visit (OR, 1.34; 95% CI, 1.10-1.62; P = .004). A similar but nonsignificant pattern was observed for HS (OR, 1.36; 95% CI, 0.96-1.93; P = .08). Patients from areas with the highest deprivation had a 62% increase in risk of either an ED visit or HS (OR, 1.62; 95% CI, 1.25-2.09; P &lt; .001). Patients with Medicare and Medicaid were 96% more likely to have an ED visit (OR, 1.96; 95% CI, 1.56-2.46; P &lt; .001).Conclusions and RelevanceIn this cohort of older patients enrolled in clinical trials, neighborhood deprivation and economic disadvantage were associated with an increase in ED visits and HS. Efforts are needed to ensure adequate resources to prevent unplanned use of acute care in socioeconomically vulnerable populations.

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Treatment and survival disparities in lung cancer: The effect of social environment and place of residence

Cited by 115 publications

References 39 publications

Urban–rural differences in cancer-directed surgery and survival of patients with non-small cell lung cancer

Urban–rural differences in cancer-directed surgery and survival of patients with non-small cell lung cancer

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

Socioeconomic Deprivation and Health Care Use in Patients Enrolled in SWOG Cancer Clinical Trials

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