Age-stratified analysis of socioeconomic disparities in non-small cell lung cancer outcomes: A National Cancer Database study.

Abstract

e13780 Background: Despite proven screening strategies and treatment advances, non-small cell lung cancer (NSCLC) remains the most lethal cancer worldwide. Persistent inequities in healthcare access for racial and ethnic minorities warrant further investigation into oncologic outcomes among patients with NSCLC at a national level. Methods: Data from the National Cancer Database (NCDB, 2004–2021) for analyzed using Kaplan-Meier and Cox models to assess survival, hazard ratios, and mortality. Analyses were stratified by age groups and adjusted for demographics, socioeconomic factors, insurance, comorbidities, and diagnosis year. Results: 1,686,789 patients were included, the majority men (51.8%), white (85%), and non-Hispanic (97.0%). Most patients had a median income (MI) of ≥$57,856 (56.5%), were Medicare-insured (63.6%), and lacked any comorbidities (57.8%). When compared to the overall patient population, patients aged 40–49 were significantly more diverse, with 16.2% being Black (vs. 10.9%), 4.4% Asian (vs. 2.8%), and 4.6% Hispanic (vs. 3.0%). Multivariate analysis revealed that females (HR: 0.76, 95% CI: 0.76-0.76, p < 0.001), Asians (HR: 0.84, 95% CI: 0.83-0.85, p < 0.001), Hispanics (HR: 0.88, 95% CI: 0.87-0.89, p < 0.001), and patients with MI ≥$57,856 (HR: 0.91, 95% CI: 0.90-0.91, p < 0.001) had better outcomes. Patients between 70-79y (HR: 1.34, 95% CI: 1.33-1.35, p < 0.001) and aged ≥80y (HR: 1.87, 95% CI: 1.85-1.89, p < 0.001) had significantly worse survival than 40-49y. Medicaid-insured (HR: 1.35, 95% CI: 1.34-1.36, p < 0.001) and uninsured individuals (HR: 1.58, 95% CI: 1.56-1.60, p < 0.001) had worse outcomes than those privately insured. Patients with ≥2 comorbidities (HR: 1.20, 95% CI: 1.20-1.21 p < 0.001) had worse survival vs. those with ≤1 . Conclusions: Despite advances in management of patients with NSCLC, significant survival disparities remain for older patients, non-Hispanics, those of lower income, alongside those with government insurance, and the uninsured. Further research is necessary to address these inequities and guide policies to improve NSCLC outcomes for underserved populations. Multivariate analysis of period-stratified NSCLC mortality risk. Year of Diagnosis n (%) Adjusted HR (95% CI) p-value 2004-2007 338,099 (20.0) Ref. -- 2008-2011 362,327 (21.5) 0.92 (0.91-0.92) <0.001 2012-2015 383,941 (22.8) 0.82 (0.82-0.83) <0.001 2016-2019 411,267 (24.4) 0.67 (0.67-0.68) <0.001 2020-2021 191,144 (11.3) 0.61 (0.60-0.61) <0.001