OBJECTIVES Studies from several countries reported socioeconomic inequalities in lung cancer survival. Hypothesized reasons are differences in cancer care or tumor characteristics. We investigated associations of small-area deprivation and lung cancer survival in Germany and the possible impact of differences in patient, tumor or treatment factors. MATERIALS AND METHODS Patients registered with a primary tumor of the lung between 2000-2015 in three German population-based clinical cancer registries were included. Area-based socioeconomic deprivation on municipality level was measured with the categorized German Index of Multiple Deprivation. Association of deprivation with overall survival was investigated with Cox regression models. RESULTS Overall, 22,905 patients were included. Five-year overall survival from the least to the most deprived quintile were 17.2%, 15.9%, 16.7%, 15.7%, and 14.4%. After adjustment for patient and tumor factors, the most deprived group had a lower survival compared to the least deprived group (Hazard Ratio (HR) 1.06, 95% confidence interval (CI) 1.01-1.11). Subgroup analyses revealed lower survival in the most deprived compared to the least deprived quintile in patients with stage I-III [HR: 1.14, 95% CI: 1.06-1.22]. The association persisted when restricting to patients receiving surgery but was attenuated for subgroups receiving either chemotherapy or radiotherapy. CONCLUSION Our results indicate differences in lung cancer survival according to area deprivation in Germany, which were more pronounced in patients with I-III stage cancer. Future research should address in more detail the underlying reasons for the observed inequalities and possible approaches to overcome them.

中文翻译：

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德国的社会经济差异和肺癌生存率：基于人群的临床癌症登记的调查。

目的来自多个国家的研究报告了肺癌生存的社会经济不平等。推测的原因是癌症治疗或肿瘤特征的差异。我们调查了德国小面积剥夺与肺癌生存的关系，以及患者，肿瘤或治疗因素差异的可能影响。材料与方法纳入2000年至2015年间在三个基于德国人群的临床癌症登记处登记为肺原发性肿瘤的患者。市政级别上基于区域的社会经济剥夺状况通过分类的德国多重剥夺指数进行了衡量。用Cox回归模型研究了剥夺与总体生存的关系。结果总共纳入22905例患者。从最低到最贫困的五分位数的五年总体生存率分别为17.2％，15.9％，16.7％，15.7％和14.4％。在对患者和肿瘤因素进行调整后，与最不贫穷的人群相比，最贫穷的人群的存活率较低（危险比（HR）1.06，95％置信区间（CI）1.01-1.11）。亚组分析显示，在I-III期患者中，最贫穷的五分之一患者的生存率低于最贫穷的五分位数[HR：1.14，95％CI：1.06-1.22]。当仅限于接受手术的患者时，这种关联持续存在，但对于接受化学疗法或放射疗法的亚组则减弱。结论我们的结果表明，根据德国的面积剥夺，肺癌生存率的差异在I-III期癌症患者中更为明显。