ASPO Abstracts

Patient- and County-Level Determinants of Surgical Treatment for Non-Small Cell Lung Cancer: A Multilevel SEER-Medicare Analysis

Authors: Odahowski CL, Alberg AJ, Zhang J, Schootman M, Eberth JM

Category: Cancer Health Disparities
Conference Year: 2020

Abstract Body:
Purpose of the study: To identify patient- and county-level determinants of receipt of surgical treatment for non- small cell lung cancer (NSCLC), focusing on rural vs. urban disparities. Methods: The study population was comprised of 63,767 localized and regional NSCLC cases diagnosed between 2003-2011 using SEER-Medicare data. Predictors examined included patient demographics, clinical characteristics and county-level factors, including urban versus rural designation, percent of the 65 and older population in poverty, and Medically Underserved Areas. Analyses examined patients nested within counties in a multilevel logistic regression model stratified by stage at diagnosis, predicting receipt of surgical treatment. Results: Rural residents were less likely to have surgery than urban residents (42.0% vs. 46.8%), and fewer black patients received surgery (32.9%) than white patients (47.1%) and those of other races (48.0%). Rural residence was not a significant predictor of surgery at the county level for local stage cases (OR=0.87, 95% CI:0.74-1.03) nor regional stage cases (OR=1.09, 95% CI:0.95-1.26). However, the odds of surgical treatment decreased per 5% increase in county-level poverty for both local and regional stages (local OR=0.83, 95% CI:0.77-0.91; regional OR=0.84, 95%CI: 0.79-0.90). Patient factors associated with lower likelihood of surgical treatment included increasing age, male sex, black race, those not married, dual Medicare/Medicaid enrollment, increasing number of comorbidities, and bilateral or midline location for both stages. Conclusions: While rural residence itself was not a significant predictor of surgical treatment, the association between county rurality and surgery was attenuated by area poverty, which is observed at higher rates among rural populations. Medicaid enrollment, a proxy measure of patient-level poverty, was also associated with a reduced likelihood of receiving surgery. Both area-level and patient-level factors were observed to contribute to the receipt of surgery among early stage lung cancer cases.

Keywords: Non-Small Cell Lung Cancer, Healthcare Disparities, Social Determinants of Health