Background: Socioeconomic deprivation has been associated with higher lung cancer risk and mortality in non-Veteran populations. However, the impact of socioeconomic deprivation on outcomes for non-small cell lung cancer (NSCLC) in an integrated and equal-access healthcare system, such as the Veterans Health Administration (VHA), remains unclear. Hence, we investigated the impact of area-level socioeconomic deprivation on access to care and postoperative outcomes for early-stage NSCLC in United States Veterans.Methods: We conducted a retrospective cohort study of patients with clinical stage I NSCLC receiving surgical treatment in the VHA between 1 October 2006 and 30 September 2016. A total of 9704 Veterans were included in the study and assigned an area deprivation index (ADI) score, a measure of socioeconomic deprivation incorporating multiple poverty, education, housing, and employment indicators. We used multivariable analyses to evaluate the relationship between ADI and postoperative outcomes as well as adherence to guideline-concordant care quality measures (QMs) for stage I NSCLC in the preoperative (positron emission tomography [PET] imaging, appropriate smoking management, pulmonary function testing [PFT], and timely surgery [≤12 weeks after diagnosis]) and postoperative periods (appropriate surveillance imaging, smoking management, and oncology referral).Results: Compared to Veterans with low socioeconomic deprivation (ADI ≤ 50), those residing in areas with high socioeconomic deprivation (ADI > 75) were less likely to have timely surgery (multivariable-adjusted odds ratio [aOR] 0.832, 95% confidence interval [CI] 0.732–0.945) and receive PET imaging (aOR 0.592, 95% CI 0.502–0.698) and PFT (aOR 0.816, 95% CI 0.694–0.959) prior to surgery. In the postoperative period, Veterans with high socioeconomic deprivation had an increased risk of 30-day readmission (aOR 1.380, 95% CI 1.103–1.726) and decreased odds of meeting all postoperative care QMs (aOR 0.856, 95% CI 0.750–0.978) compared to those with low socioeconomic deprivation. There was no association between ADI and overall survival (adjusted hazard ratio [aHR] 0.984, 95% CI 0.911–1.062) or cumulative incidence of cancer recurrence (aHR 1.047, 95% CI 0.930–1.179).Conclusions: Our results suggest that Veterans with high socioeconomic deprivation have suboptimal adherence to care QMs for stage I NSCLC yet do not have inferior long-term outcomes after curative-intent resection. Collectively, these findings demonstrate the efficacy of an integrated, equal-access healthcare system in mitigating disparities in lung cancer survival that are frequently present in other populations. Future VHA policies should continue to target increasing adherence to QMs and reducing postoperative readmission for socioeconomically disadvantaged Veterans with early-stage NSCLC.
背景：在非退伍军人群体中，社会经济剥夺与较高的肺癌风险和死亡率相关。然而，在退伍军人健康管理局（VHA）这类整合式、平等就医的医疗体系中，社会经济剥夺对非小细胞肺癌（NSCLC）患者结局的影响尚不明确。因此，本研究探讨了地区层面社会经济剥夺对美国退伍军人早期NSCLC患者就医机会及术后结局的影响。 方法：我们对2006年10月1日至2016年9月30日期间在VHA接受手术治疗的临床I期NSCLC患者进行了一项回顾性队列研究。共纳入9704名退伍军人，并为其分配了地区剥夺指数（ADI）评分，该指数综合了贫困、教育、住房和就业等多重指标以衡量社会经济剥夺程度。通过多变量分析评估ADI与术后结局的关系，以及I期NSCLC患者在术前（正电子发射断层扫描[PET]成像、规范吸烟管理、肺功能检测[PFT]及及时手术[诊断后≤12周]）和术后（规范随访影像学检查、吸烟管理及肿瘤科转诊）阶段对指南一致性护理质量指标（QMs）的依从性。 结果：与低社会经济剥夺（ADI ≤ 50）的退伍军人相比，居住在高社会经济剥夺地区（ADI > 75）的患者接受及时手术（多变量校正比值比[aOR] 0.832，95%置信区间[CI] 0.732–0.945）、术前PET成像（aOR 0.592，95% CI 0.502–0.698）及PFT检查（aOR 0.816，95% CI 0.694–0.959）的可能性更低。术后阶段，高社会经济剥夺患者30天再入院风险更高（aOR 1.380，95% CI 1.103–1.726），且达到所有术后护理QMs标准的概率更低（aOR 0.856，95% CI 0.750–0.978）。ADI与总生存期（校正风险比[aHR] 0.984，95% CI 0.911–1.062）或癌症复发累积发生率（aHR 1.047，95% CI 0.930–1.179）无显著关联。 结论：研究结果表明，高社会经济剥夺的退伍军人对I期NSCLC护理QMs的依从性欠佳，但在根治性切除术后并未出现更差的长期结局。这些发现共同证明，整合式、平等就医的医疗体系能有效缓解其他人群中常见的肺癌生存差异。未来VHA政策应继续致力于提高社会经济弱势早期NSCLC退伍军人的QMs依从性，并降低其术后再入院率。
肿瘤(癌症)患者之家