Geographic residency and social envirnment as determinants of lung cancer outcomes

Objectives: The purpose of this study is to measure the extent to which geographic differences are associated with the odds of receiving treatment and five year survival rates for patients diagnosed with Non Small Cell Lung Cancer (NSCLC). Methods and variables: This study uses a cohort of cancer incidences between January 2000 to December 2009. Social envirnment and geographic residency are exposures of interest. The patient level data were merged with Census 2000 data and utilizing factor analysis two composite variables were created ; ecenemic deprivation, and educational attainment. Data were also merged with Rural Urban Commuting Area (RUCA) codes provided by the US Department of Agriculture resuting in a variable measuring levels of rurality. We employed multi-level logistic models for outcome variables; unstaged and late stage diagnoses, and receiving treatment. We also conducted the analysis of survival time until death. In all models tumor stage, tumor grade, age, race, and sex were controlled Results: In treatment models, it was suggested that rural residents have lower odds of receiving any type of treatment, compared to the urban dwellers. Meanwhile living in areas with higher concentration of deprivation and lower levels of education, was associated with significantly lower odds of receiving treatment. Living in areas with higher concentration of deprivation and lower levels of education was associated with poorer survival. Conclusion: Future efforts should focus on developing interventions and policies that target rural or impoverished areas.