Lung cancer survival is worse in Florida men compared with women

Background: Previous studies revealed a sex disparity in lung cancer survival, however, these studies did not control for all confounding variables. We pooled 2 large Florida population-based datasets to examine associations between sex and survival while controlling for extensive factors.

Methods: Data from the Florida Cancer Data System registry (identifying lung cancer patients) were linked to the Florida Agency for Health Care Administration (identifying comorbidities) for patients diagnosed from 1996-2007 (n=165,465). Survival time by sex was our primary endpoint. Univariate and multivariate adjusted Cox regression models were performed controlling for race, ethnicity, socioeconomic status, smoking status, insurance, marital status, hospital characteristics, treatment, stage, grade, and comorbidities.

Results: The majority of the sample was male (55.7%), married (53.2%) and insured (86.1%). Mean age at diagnosis was 70 years (SD, 11.2). Women (70.6%) were less likely than men (75.6%) to be current or former smokers and to be diagnosed with distant disease (38.7 vs. 40.9%). Median survival time in months for women was 9.6 vs. 7.1 for men. Survival rates at 1- and 5-years post-diagnosis were higher for women (44.4%, 15.0%) than men (36.4%, 9.7%). In the univariate model, compared to women, men had worse survival (hazard ratio [HR] 1.23; 95%Confidence Interval [95%CI]=1.22- 1.25). In the fully adjusted model worse survival was maintained in men (HR 1.17; 95%CI=1.15-1.19).

Discussion: When accounting for extensive confounding variables, men diagnosed with lung cancer had a 17% survival disadvantage compared with women. Future research should examine if Florida men are following screening recommendations for lung cancer.