Objectives:Survival from lung cancer is worse in the UK than in some other countries, with late stage at diagnosis implicated in poor prognosis. The route and referral urgency by which patients obtain a diagnosis influence outcomes. This study investigated whether socio-demographic factors are associated with lung cancer routes to diagnosis in England.Materials and Methods:A total of 181,763 primary invasive lung cancers (ICD-10 C34.0-C34.9) diagnosed from 1 January 2012 to 31 December 2016 were abstracted from the English National Cancer Registration Database. Multivariable logistic regression was used to examine associations between patients’ socio-demographic characteristics and likelihood (adjusted odds ratios) of (i) emergency presentation versus all primary care-initiated routes and (ii) urgent (“two-week wait”/2WW) versus standard primary care-initiated referral. Models included the following factors: deprivation quintile of area of residence at diagnosis (IMD income domain); sex; age; ethnic group; rural/urban residence; and (in the emergency model) region.Results:Socio-demographic variations in diagnosis routes were observed. Patients presenting as emergencies (35.2%) were more likely to be 80 years of age or older, female, of non-White ethnicity, and resident in areas of greater deprivation or the London region. In contrast, 2WW patients (28.3%) were more likely to be aged between 50 and 69 years old, of White ethnicity, and resident in an area of greater deprivation or resident outside of an urban centre; diagnosis through 2WW did not vary by sex.Conclusions:Routes to diagnosis are subject to distinct socio-demographic patterning. Action is needed to ensure that new referral guidelines and lung cancer screening roll-out do not widen socio-demographic inequalities in diagnosis.
目的：英国肺癌患者的生存率低于部分其他国家，诊断时已处于晚期是预后不良的重要因素。患者获得诊断的途径和转诊紧急程度会影响治疗结果。本研究旨在探讨英格兰地区肺癌诊断途径是否与社会人口学因素相关。 材料与方法：从英国国家癌症登记数据库中提取2012年1月1日至2016年12月31日期间确诊的181,763例原发性浸润性肺癌（ICD-10编码C34.0-C34.9）。采用多变量逻辑回归分析患者社会人口学特征与以下两种情况的关联性（调整后比值比）：（1）急诊就诊与所有初级保健转诊途径的对比；（2）紧急转诊（"两周等待期"/2WW）与标准初级保健转诊的对比。模型纳入以下变量：诊断时居住区域贫困程度五分位数（IMD收入维度）、性别、年龄、种族、城乡居住地，以及（急诊模型中）地区因素。 结果：诊断途径存在显著的社会人口学差异。通过急诊就诊的患者（35.2%）更可能具有以下特征：年龄≥80岁、女性、非白人种族、居住于高贫困地区或伦敦地区。相比之下，通过2WW途径确诊的患者（28.3%）更可能具有以下特征：年龄50-69岁、白人种族、居住于高贫困地区或非城市中心区域；2WW诊断途径不存在性别差异。 结论：肺癌诊断途径呈现明显的社会人口学分布特征。需要采取相应措施，确保新的转诊指南和肺癌筛查计划的实施不会加剧诊断途径中的社会人口学不平等。
Routes to Diagnosis in Lung Cancer—Do Socio-Demographics Matter? An English Population-Based Study
肿瘤(癌症)患者之家