Paper Information

We identified 557,555 patients aged 25+ years diagnosed with lung/bronchus carcinoma from the SEER database, 2000-2016. We estimated hazard ratios (HR) for demographic (sex, age, race and ethnicity), tumor (stage, histology, year of diagnosis), and geographic characteristics (census-tract-level urbanicity, socioeconomic status (SES)), as well as selected interactions, on the rate of lung-cancer-specific death using multivariable proportional hazards models.

Disparities in survival after lung cancer diagnosis remain, with intersectional patterns suggesting differential access to and quality of care. Efforts are needed to ensure high-risk groups receive guideline-concordant treatment.

Understanding the impact of patient and tumor characteristics on lung cancer survival can help to build personalized prognostic models and identify health disparities.

Females had a higher survival (lower hazard) of lung-cancer-specific death than males (HR 0.83, 95% CI: 0.82, 0.83). Hazards differed by race and ethnicity. Regional (HR: 2.41, 95% CI: 2.37, 2.44) and distant (HR: 6.61, 95% CI: 6.53, 6.69) tumors were associated with a lower survival (higher hazard) than localized tumors. Small-cell tumors were associated with a lower survival (HR 1.19, 95% CI: 1.18, 1.20) than non-small-cell tumors. Patients diagnosed after 2009 had lower hazards (HR 0.86, 95% CI: 085, 0.86) than those diagnosed 2000-2009. Lung-cancer-specific survival did not depend on urbanicity after adjusting for census-tract-level SES, but survival decreased with decreasing census-tract-level SES. Differences in survival between non-Hispanic Black and White patients were greater for younger patients and localized tumors and increased with census-tract-level SES. Differences by sex were greatest for young patients and localized tumors.