Associations Between Socioeconomic Status at Death Following Lung Cancer Surgery Explored in New Study

According to a recent study published in the Journal of the American College of Surgeons, people with low income and limited education are more likely to die within 30 days following a lung cancer surgery in comparison to those who are financially better and who are more educated.

“In order to get uniform superior outcomes for our patients, we need to identify the patients who are at risk for worse outcomes,” said study co-author Felix G. Fernandez, MD, FACS, a lung surgeon and an assistant professor of surgery at Emory University School of Medicine in Atlanta in a recent press release. “This is the first step in describing where those disparities exist.”

In the study titled “Nonclinical Factors Associated with 30-Day Mortality after Lung Cancer Resection: An Analysis of 215,000 Patients Using the National Cancer Data Base,” the research team conducted a retrospective cohort analysis of 215,645 patients who underwent lung cancer resection between 2003 and 2011, using the National Cancer Data Base (NCDB). The NCDB is joint program of the American Cancer Society and the American College of Surgeons and is the largest U.S. cancer database providing patient demographic information, diagnosis, insurance status, treatment and patient survival after treatment. NCDB captures an estimated 70% of newly diagnosed cancers from about 1,500 cancer programs accredited by the Commission on Cancer of the American College of Surgeons.

Data was analyzed using a multivariable logistic regression to identify risk factors for 30-day mortality, with results revealing an association between 30-day mortality after resection and age, gender, preoperative radiation, cancer stage, comorbidity, extent of resection, positive surgical margins, and tumor size.

Nevertheless, the results also revealed that non-clinical factors such as living in lower income neighborhoods with a lower proportion of high school graduates and receiving cancer care at a non-academic medical center were associated with an increase in mortality after 30-day of lung cancer resection.

The researchers also found that patients with an average household income of less than $30,000 had 25% more chances of death within 30 days after lung cancer resection surgery compared to those living in neighborhoods with an average household income higher than $46,000.

Similar results were observed when considering patients from communities with less education as these patients were 16% more likely to die within 30 days following surgery when compared to those from communities with better education.

The findings also showed there was an association between the type of hospital where patients were treated, comprehensive center or academic research center — and 30-day mortality.

Patients who had their surgery at a community hospital or at a comprehensive center were 34%  and 22% more likely to die within 30 days, respectively, in comparison to those who had their surgery at an academic medical center.

“The quality of care needs to be uniform across the country for high risk procedures, so that regardless of the treatment center, whether it is a community hospital or big academic tertiary care center, the results are going to be similar,” Dr. Fernandez said in the news release.

According to researchers, from 2007 to 2013, in the U.S. there was an increase in income discrepancies and poverty from 2.7% to 15%, representing a total of 46 million Americans, which means that the number of patients with lung cancer at increased risk for short-term postoperative mortality may still rise.

This was the largest study to date to evaluate the association between 30 days mortality in patients undergoing lung cancer surgical resection and socioeconomic factors, with researchers suggesting that future studies should look at why there are worse clinical outcomes in patients with less income and limited education. “It’s a very powerful study because it has the largest and most complete data on cancer care that we have for our use in the world,” Dr. Fernandez said in a news release. “Clearly, our results show that patients who come from less educated and less wealthy communities are at risk for mortality with the lung cancer operation.”

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