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Social differences in lung cancer management and survival in South East England: a cohort study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
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2012 (English)In: BMJ Open, ISSN 2044-6055, Vol. 2, no 3, e001048- p.Article in journal (Refereed) Published
Abstract [en]


To examine possible social variations in lung cancer survival and assess if any such gradients can be attributed to social differences in comorbidity, stage at diagnosis or treatment.


Population-based cohort identified in the Thames Cancer Registry.


South East England.


15 582 lung cancer patients diagnosed between 2006 and 2008.


Stage at diagnosis, surgery, radiotherapy, chemotherapy and survival.


The likelihood of being diagnosed as having early-stage disease did not vary by socioeconomic quintiles (p=0.58). In early-stage non-small-cell lung cancer, the likelihood of undergoing surgery was lowest in the most deprived group. There were no socioeconomic differences in the likelihood of receiving radiotherapy in stage III disease, while in advanced disease and in small-cell lung cancer, receipt of chemotherapy differed over socioeconomic quintiles (p<0.01). In early-stage disease and following adjustment for confounders, the HR between the most deprived and the most affluent group was 1.24 (95% CI 0.98 to 1.56). Corresponding estimates in stage III and advanced disease or small-cell lung cancer were 1.16 (95% CI 1.01 to 1.34) and 1.12 (95% CI 1.05 to 1.20), respectively. In early-stage disease, the crude HR between the most deprived and the most affluent group was approximately 1.4 and constant through follow-up, while in patients with advanced disease or small-cell lung cancer, no difference was detectable after 3 months.


We observed socioeconomic variations in management and survival in patients diagnosed as having lung cancer in South East England between 2006 and 2008, differences which could not fully be explained by social differences in stage at diagnosis, co-morbidity and treatment. The survival observed in the most affluent group should set the target for what is achievable for all lung cancer patients, managed in the same healthcare system.

Place, publisher, year, edition, pages
2012. Vol. 2, no 3, e001048- p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-182970DOI: 10.1136/bmjopen-2012-001048ISI: 000315044800072PubMedID: 22637374OAI: oai:DiVA.org:uu-182970DiVA: diva2:561590
Available from: 2012-10-19 Created: 2012-10-19 Last updated: 2013-03-26Bibliographically approved

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Berglund, AndersHolmberg, Lars
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