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The impact of social determinants of health on management of stage I non-small cell lung cancer

Published:October 15, 2021DOI:https://doi.org/10.1016/j.amjsurg.2021.10.022

      Highlights

      • Social determinants of health (SDOH)_Highlights:
      • In a large dataset of US cancer patients, SDOH affected treatment choices and outcomes of patients with stage I lung cancer.
      • Patients with SDOH disparities were less likely to receive surgery and had worse overall long term survival.
      • Surgical patients with SDOH disparities had minimally invasive surgery less frequently and had worse postoperative outcomes.

      Abstract

      Background

      Social Determinants of Health (SDOH) can be important contributors in health care outcomes. We hypothesized that certain SDOH independently impact the management and outcomes of stage I Non-Small Cell Lung Cancer (NSCLC).

      Study design

      Patients with clinical stage I NSCLC were identified from the National Cancer Database. The impact of SDOH factors on utilization of surgery, perioperative outcomes and overall survival were examined, both in bivariate and multivariable analyses.

      Results

      A total of 236,140 patients were identified. In multivariate analysis, SDOH marginalization were associated with less frequent use of surgery, lower 5-year survival and, in surgical patients, more frequent use of open surgery and lower 90-day postoperative survival.

      Conclusion

      SDOH disparities have a significant impact in the management and outcomes of stage I NSCLC. We identified SDOH patient groups particularly impacted by such disparities, in which higher utilization of surgery and minimally invasive approaches may lead to improved outcomes.

      Keywords

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