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Association of area-level socioeconomic status and non-small cell lung cancer stage by race/ethnicity and health care-level factors: Analysis of the National Cancer Database.

Publication ,  Journal Article
Gupta, A; Omeogu, CH; Islam, JY; Joshi, AR; Akinyemiju, TF
Published in: Cancer
August 15, 2022

BACKGROUND: This study examined whether the association of socioeconomic status (SES) and non-small cell lung cancer (NSCLC) stage varied by race/ethnicity and health care access measures. METHODS: This study used data from the 2004-2016 National Cancer Database for patients aged 18-89 years who had been diagnosed with Stage 0-IV NSCLC. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated for the associations of area-level SES with an advanced stage at diagnosis via multilevel, multivariable logistic regression. The stage at diagnosis was dichotomized into early (0-II) and advanced (III-IV) stages, and area-level SES was categorized on the basis of the patient's zip code level: (1) the proportion of adults aged ≥25 years without a high school degree and (2) the median household income. The models were stratified by race/ethnicity (non-Hispanic [NH] White, NH Black, Hispanic, Asian, American Indian/Alaskan Native, and Native Hawaiian/Pacific Islander), insurance status (none, government, and private), and health care facility type (community, comprehensive community, academic/research, and integrated network). RESULTS: The study population included 1,329,972 patients. Although only 17% of the NH White patients were in the lowest income quartile, 50% of the NH Black patients were in this group. Lower area-level education and income were associated with higher odds of an advanced-stage diagnosis (aOR for education, 1.12; 95% CI, 1.10-1.13; aOR for income, 1.13; 95% CI, 1.11-1.14). These associations persisted among NH White, NH Black, Hispanic, and Asian patients; among those with government and private insurance (but not the uninsured); and among those treated at each facility type. CONCLUSIONS: Area-level income and education are strongly associated with an advanced NSCLC diagnosis regardless of the facility type and among those with government and private insurance.

Duke Scholars

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Published In

Cancer

DOI

EISSN

1097-0142

Publication Date

August 15, 2022

Volume

128

Issue

16

Start / End Page

3099 / 3108

Location

United States

Related Subject Headings

  • United States
  • Socioeconomic Factors
  • Social Class
  • Oncology & Carcinogenesis
  • Lung Neoplasms
  • Humans
  • Health Services Accessibility
  • Ethnicity
  • Carcinoma, Non-Small-Cell Lung
  • Adult
 

Citation

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Gupta, A., Omeogu, C. H., Islam, J. Y., Joshi, A. R., & Akinyemiju, T. F. (2022). Association of area-level socioeconomic status and non-small cell lung cancer stage by race/ethnicity and health care-level factors: Analysis of the National Cancer Database. Cancer, 128(16), 3099–3108. https://doi.org/10.1002/cncr.34327
Gupta, Anjali, Chioma H. Omeogu, Jessica Y. Islam, Ashwini R. Joshi, and Tomi F. Akinyemiju. “Association of area-level socioeconomic status and non-small cell lung cancer stage by race/ethnicity and health care-level factors: Analysis of the National Cancer Database.Cancer 128, no. 16 (August 15, 2022): 3099–3108. https://doi.org/10.1002/cncr.34327.
Journal cover image

Published In

Cancer

DOI

EISSN

1097-0142

Publication Date

August 15, 2022

Volume

128

Issue

16

Start / End Page

3099 / 3108

Location

United States

Related Subject Headings

  • United States
  • Socioeconomic Factors
  • Social Class
  • Oncology & Carcinogenesis
  • Lung Neoplasms
  • Humans
  • Health Services Accessibility
  • Ethnicity
  • Carcinoma, Non-Small-Cell Lung
  • Adult