Socioeconomic position, stage of lung cancer, and time between referral and diagnosis in Denmark, 2001-2008.

Abstract

6050 Background: Social inequality in short-term relative survival has been reported among men with lung cancer in Denmark. We investigated the association between socioeconomic position, stage at diagnosis and length of period between referral and diagnosis in a nationwide cohort of patients with lung cancer diagnosed in Denmark. Methods: From the Danish Lung Cancer Register, we identified all 18 103 people in whom non-small cell lung cancer or small cell lung cancer was diagnosed in 2001–2008 for whom we could identify socioeconomic position and comorbidity in nationwide administrative registries. The risks for a diagnosis of advanced-stage lung cancer (stages IIIB–IV) and for a diagnosis more than 28 days after referral were analyzed by multivariate logistic regression, with adjustment for age, gender, socioeconomic factors and comorbidity. Results: The adjusted odds ratio (OR) for advanced-stage lung cancer was reduced by 8% among people with longer education (95% confidence interval (CI), 0.84;0.99) and was increased in people living alone (OR, 1.06; 95% CI, 1.01;1.13). The ORs decreased in a stepwise fashion with increasing comorbidity score. Higher education was associated with a reduced OR of a period > 28 days between referral and diagnosis (0.82; 95% CI, 0.70;0.96 for early-stage and 0.82, 95% CI, 0.72;0.93 for advanced-stage), as was high income in early-stage cases. Male gender, age and severe comorbidity were associated with increased ORs in advanced-stage cases. Conclusions: Differences by socioeconomic position and comorbidity were found in the period between referral and diagnosis and in stage at diagnosis, indicating that vulnerable patients presenting with lung cancer symptoms require special attention.