County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

• Published in: Chest Vol. 157; no. 1; pp. 212 - 222
• Main Authors: Sineshaw, Helmneh M., Sahar, Liora, Osarogiagbon, Raymond U., Flanders, W. Dana, Yabroff, K. Robin, Jemal, Ahmedin
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2020; American College of Chest Physicians
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung - epidemiology; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; epidemiology; Female; health-care disparities; health-care utilization; Humans; Lung Neoplasms - epidemiology; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Middle Aged; Neoplasm Staging; Original Research; Practice Patterns, Physicians' - statistics & numerical data; Registries; research-clinical; surgery oncology; United States - epidemiology; United States; epidemiology; surgery oncology; health-care utilization; health-care disparities; NSCLC; research-clinical; NAACCR
• ISSN: 0012-3692; 1931-3543; 1931-3543
• DOI: 10.1016/j.chest.2019.09.016

Although counties are the smallest geographic level for comprehensive health-care delivery analysis, little is known about county-level variations in receipt of curative-intent surgery for early-stage non-small cell lung cancer (NSCLC) and factors contributing to such variations in the United States. A total of 179,189 patients aged ≥ 35 years who were diagnosed with stage I to II NSCLC between 2007 and 2014 in 2,263 counties were identified from 39 states, the District of Columbia, and Detroit population-based cancer registries; the data were compiled by the North American Association of Central Cancer Registries. The percentage of patients who underwent surgery was calculated for each county with ≥ 20 cases. Adjusted risk ratios were generated by using generalized estimating equation models with modified Poisson regression. Receipt of surgery for early-stage NSCLC during 2007 to 2014 according to county ranged from 12.8% to 48.6% in the lowest decile of counties, to 74.3% to 91.7% in the highest decile of counties. There were pockets of low surgery receipt rate counties within each state. For example, there was a 25% absolute difference between the lowest and highest surgery receipt rate counties in Massachusetts. Counties in the lowest quartile for receipt of surgery were those with a high proportion of non-Hispanic black subjects, high poverty and uninsured rates, low surgeon-to-population ratio, and nonmetropolitan status. Receipt of curative-intent surgery for early-stage NSCLC varied substantially across counties in the United States, with pockets of low receipt counties in each state. Low surgery receipt counties were characterized by unfavorable area-level socioeconomic and health-care delivery factors.