Social factors, treatment, and survival in early-stage non-small cell lung cancer

Objectives. This study assessed the importance of socioeconomic status, race, and likelihood of receiving surgery in explaining mortality among patients with stage-I non-small cell lung cancer. Methods. Analyses focused on Black and White individuals 75 years of age and younger (n=5189) diagnosed between 1980 and 1982 with stage-I non-small cell lung cancer in Detroit, San Francisco, and Seattle. The main outcome measure was months of survival after diagnosis. Results. Patients in the highest income decile were 45% more likely to receive surgical treatment and 102% more likely to attain 5-year survival than those in the lowest decile. Whites were 20% more likely to undergo surgery than Blacks and 31% more likely to survive 5 years. Multivariate procedures controlling for age and sex confirmed these observations. Conclusions. Socioeconomic status and race appear to independently influence likelihood of survival. Failure to receive surgery explains much excess mortality.