Risk of Late Non-Small Cell Lung Cancer Impacted by Income and Education

On June 20, an article was published highlighting that income and education impacted the risk of late diagnosis of non-small cell lung cancer (NSCLC). The study noted that areas with lower income and education levels saw more patients diagnosed with NSCLC later in disease progression.  

Of the two forms of lung cancer, NSCLC is the most common, comprising over 80% of all lung cancers. According to the American Society of Clinical Oncology, approximately 236,740 adults in the United States are diagnosed with lung cancer annually.  

In the US, approximately 25% of all cancer-related deaths are due to some form of lung cancer. Cancer prognoses greatly diminish in patients where the diagnosis occurs at a later stage.  

The American Cancer Society outlines different treatment protocols based on the cancer stage. At stage 0, surgery to remove the cancerous cells is typically the first and only line of defense.  

As the stages progress, so do the treatments. For advanced-stage NSCLC, treatments are more aggressive and may increase the risk of adverse side effects.   

Using the National Cancer Database, this study looked at patients between 18 and 89 years old diagnosed from 2004 to 2016. The stages of diagnosis were divided into early and advanced. Early stages were identified as stages 0, I, or II. Stages III and IV were labeled as advanced.  

To quantify socioeconomic status, the researchers examined area-level income and education by zip code. 

“In this analysis of patients with NSCLC recorded in the NCDB, we demonstrated that lower area-level socioeconomic factors, defined by the area-level median income and the area-level high school graduation rate, were associated with an advanced stage at NSCLC diagnosis,” stated the researchers in the publication.  

This statement is held across all races. The study also corroborated previous evidence that Black patients had an increased risk of late diagnosis of NSCLC. It showed that, compared to White patients in the lowest income and education group, Black patients in the highest educational and income group still had a higher rate of late diagnosis. 

Understanding how the social determinants of health contribute to disease diagnosis can impact treatment plans, research, and innovation in the care of these illnesses.  

The researchers concluded the study by saying, “these findings highlight the need for efforts to evaluate and address social determinants of health (specifically financial and healthcare access factors) as part of a comprehensive public health strategy to improve lung cancer outcomes across racial groups.”