Socioeconomic disparities in immunotherapy use among advanced-stage non-small cell lung cancer patients: analysis of the National Cancer Database

被引:19
作者
Gupta, Anjali [1 ]
Omeogu, Chioma [1 ]
Islam, Jessica Y. [1 ,2 ]
Joshi, Ashwini [1 ]
Zhang, Dongyu [3 ]
Braithwaite, Dejana [4 ]
Karanth, Shama D. [5 ]
Tailor, Tina D. [6 ]
Clarke, Jeffrey M. [7 ]
Akinyemiju, Tomi [1 ]
机构
[1] Duke Univ, Sch Med, Dept Populat Hlth Sci, 215 Morris St, Durham, NC 27708 USA
[2] H Lee Moffitt Canc Ctr & Res Inst, Canc Epidemiol Program, Tampa, FL USA
[3] Johnson & Johnson, Med Device Epidemiol, New Brunswick, NJ USA
[4] Univ Florida, Dept Epidemiol, Gainesville, FL USA
[5] Univ Florida, Inst Aging, Gainesville, FL USA
[6] Duke Univ, Dept Radiol, Sch Med, Durham, NC USA
[7] Duke Univ, Dept Med, Sch Med, Durham, NC USA
关键词
MORTALITY; SURVIVAL; WOMEN; RACE;
D O I
10.1038/s41598-023-35216-2
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Socioeconomic and racial disparities exist in access to care among patients with non-small cell lung cancer (NSCLC) in the United States. Immunotherapy is a widely established treatment modality for patients with advanced-stage NSCLC (aNSCLC). We examined associations of area-level socioeconomic status with receipt of immunotherapy for aNSCLC patients by race/ethnicity and cancer facility type (academic and non-academic). We used the National Cancer Database (2015-2016), and included patients aged 40-89 years who were diagnosed with stage III-IV NSCLC. Area-level income was defined as the median household income in the patient's zip code, and area-level education was defined as the proportion of adults aged >= 25 years in the patient's zip code without a high school degree. We calculated adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) using multi-level multivariable logistic regression. Among 100,298 aNSCLC patients, lower area-level education and income were associated with lower odds of immunotherapy treatment (education: aOR 0.71; 95% CI 0.65, 0.76 and income: aOR 0.71; 95% CI 0.66, 0.77). These associations persisted for NH-White patients. However, among NH-Black patients, we only observed an association with lower education (aOR 0.74; 95% CI 0.57, 0.97). Across all cancer facility types, lower education and income were associated with lower immunotherapy receipt among NH-White patients. However, among NH-Black patients, this association only persisted with education for patients treated at non-academic facilities (aOR 0.70; 95% CI 0.49, 0.99). In conclusion, aNSCLC patients residing in areas of lower educational and economic wealth were less likely to receive immunotherapy.
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页数:9
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