Neighborhood Socioeconomics and Lung Cancer Recurrence and Progression

Abstract

Introduction/Background

In the United States, about 50% of patients with lung cancer, across all stages, experience recurrence or progression even after undergoing successful treatment. Though research has been conducted on the risk of lung cancer recurrence and progression, the impact of neighborhood socioeconomic status has not been investigated.

Materials and Methods

We examined associations of neighborhood socioeconomic status (nSES) with lung cancer recurrence and progression among 3439 non–small cell lung cancer patients in the follow-up period from 1992 to 2012 in the Boston Lung Cancer Study. The nSES variables, including education level and annual household income, were estimated utilizing patient zip code and census tract data. Multivariable Cox regression was used to estimate associations.

Results

A total of 496 lung cancer recurrence and progression cases were observed in our study population. Patients living in zip codes where the majority of the population had fewer than four years of college education and an annual household income of less than $75,000 had a 2% and 10% increased hazard of lung cancer recurrence or progression, respectively; moreover, for every 10% increase in the neighborhood population that had less than 4 years of college education and had an annual household income of less than $75,000, patients had a 3% and 3% increased hazard of lung cancer recurrence or progression, respectively.

Conclusions

These findings suggest that nSES is associated with the risk of lung cancer recurrence and progression, with evidence of a potential exposure-response relationship. Disadvantaged neighborhoods may therefore represent a critical target for health policies and interventions aimed at reducing morbidity and mortality.