Differences in Lung Cancer Survival by Demographic Characteristics and Social Determinants of Health,United States,2010-2020

Abstract

Objectives:

Common data sources that examine cancer survival provide limited information on health behaviors or social determinants of health. We linked individual-level cancer registry data to county-level data to examine differences in survival among people diagnosed with lung cancer.

Methods:

We linked 2010-2020 National Program of Cancer Registries survival data from 40 registries, covering 85% of the US population, to county-level data on current age-adjusted cigarette smoking prevalence, average daily density of fine particulate matter (PM_2.5) in µg/m³ (fine particulate pollution), and overall social vulnerability. We generated Kaplan–Meier survival curves and used multivariable Cox proportional hazards regression to examine overall and cause-specific survival among people aged ≥20 years diagnosed with lung cancer.

Results:

Survival was significantly lower among people who lived in counties with a higher prevalence of cigarette smoking of 14.3% to <17.0% (adjusted hazard ratio [AHR] = 1.06), 17.0% to <20.2% (AHR = 1.08), and 20.2% to 34.8% (AHR = 1.14) compared with 6.7% to <14.3%; fine particulate pollution >12.0 µg/m³ versus ≤12.0 µg/m³ (AHR = 1.04); and social vulnerability scores in the second (AHR = 1.01), third (AHR = 1.02), and fourth (AHR = 1.03) quartiles versus first quartile. Individual-level covariates significantly associated with rates of survival included sex, age at diagnosis, race and ethnicity, histology, stage at diagnosis, receiving surgery during first course of treatment, year of diagnosis, and US Census region.

Conclusions:

Multiple characteristics were associated with lower 5-year lung cancer survival rates. Interventions that address these characteristics (eg, promoting tobacco cessation, reducing exposure to fine particulate pollution) may lead to longer survival after lung cancer diagnosis.