Abstract
Introduction: Rural lung cancer patients experience worse survival than urban lung cancer patients. Worse survival in early-stage rural lung cancer patients may be due lower utilization of surgical treatment compared to their urban counterparts. We examined patient- and county-level determinants of surgical treatment for non-small cell lung cancer, focusing on rural vs. urban disparities. Methods: Our sample included 63,767 localized and regional NSCLC cases diagnosed between 2003-2011 using SEER-Medicare data. Predictors examined included demographics, clinical characteristics, and county factors (urban versus rural designation, percent of the population ≥65 years old below 100% Federal Poverty Limit, and designation as a Medically Underserved Area). Patient characteristics were nested within counties in multilevel logistic regression models stratified by stage at diagnosis, predicting receipt of surgical treatment. Results: Rural residents were less likely to receive surgical treatment than urban residents (42.0% vs. 46.8%, p<0.01), and black patients were less likely than white patients to receive surgery (32.9% vs. 47.1%, p<0.01). Rurality did not remain a significant factor in the final adjusted model. The final model showed an odds of surgical treatment decreased for every 5% increase in county-level poverty for both local stage (OR=0.83, 95% CI:0.77-0.91) and regional stage (OR=0.84, 95%CI: 0.79-0.90). Other patient factors associated with lower likelihood of surgical treatment included older age, male sex, non-married, dual Medicare/Medicaid enrollment, and more comorbidities. Conclusions: Rurality was not associated with receipt of surgery in the final multilevel model, but patient race and county-level poverty were significantly associated with a lower odds of surgery. Future research is needed to understand the causes of these disparities in surgical treatment of lung cancer to maximize survival for all populations.
Citation Format: Cassie Lewis Odahowski, Anthony J. Alberg, Mario Schootman, Jiajia Zhang, Jan M. Eberth. Patient and county level determinants of surgical treatment for non-small cell lung cancer: A SEER-Medicare analysis [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-118.
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