Background Understanding the impact of patient and tumor characteristics on lung cancer survival can help to build personalized prognostic models and identify health disparities. Methods We identified 557,555 patients aged 25+ years diagnosed with lung/bronchus carcinoma from the SEER database, 2000–2016. We estimated hazard ratios (HR) for demographic (sex, age, race and ethnicity), tumor (stage, histology, year of diagnosis), and geographic characteristics (census-tract-level urbanicity, socioeconomic status (SES)), as well as selected interactions, on the rate of lung-cancer-specific death using multivariable proportional hazards models. Results Females had a higher survival (lower hazard) of lung-cancer-specific death than males (HR 0.83, 95% CI: 0.82, 0.83). Hazards differed by race and ethnicity. Regional (HR: 2.41, 95% CI: 2.37, 2.44) and distant (HR: 6.61, 95% CI: 6.53, 6.69) tumors were associated with a lower survival (higher hazard) than localized tumors. Small-cell tumors were associated with a lower survival (HR 1.19, 95% CI: 1.18, 1.20) than non-small-cell tumors. Patients diagnosed after 2009 had lower hazards (HR 0.86, 95% CI: 085, 0.86) than those diagnosed 2000–2009. Lung-cancer-specific survival did not depend on urbanicity after adjusting for census-tract-level SES, but survival decreased with decreasing census-tract-level SES. Differences in survival between non-Hispanic Black and White patients were greater for younger patients and localized tumors and increased with census-tract-level SES. Differences by sex were greatest for young patients and localized tumors. Conclusions Disparities in survival after lung cancer diagnosis remain, with intersectional patterns suggesting differential access to and quality of care. Efforts are needed to ensure high-risk groups receive guideline-concordant treatment.

中文翻译：

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2000-2016 年美国肺癌的社会人口生存差异

背景了解患者和肿瘤特征对肺癌生存的影响有助于建立个性化预后模型并确定健康差异。方法 我们从 2000 年至 2016 年 SEER 数据库中确定了 557,555 名 25 岁以上诊断患有肺癌/支气管癌的患者。我们估计了人口统计（性别、年龄、种族和民族）、肿瘤（分期、组织学、诊断年份）和地理特征（人口普查区城市化、社会经济地位（SES））的风险比（HR）。作为选定的相互作用，使用多变量比例风险模型研究肺癌特异性死亡率。结果 女性肺癌特异性死亡的生存率高于男性（HR 0.83，95% CI：0.82，0.83）。危险因种族和民族而异。区域性肿瘤（HR：2.41，95% CI：2.37，2.44）和远处肿瘤（HR：6.61，95% CI：6.53，6.69）与局部肿瘤相比，生存率较低（风险较高）。与非小细胞肿瘤相比，小细胞肿瘤的生存率较低（HR 1.19，95% CI：1.18，1.20）。2009 年之后诊断的患者比 2000-2009 年诊断的患者风险更低（HR 0.86，95% CI：085，0.86）。在对人口普查区水平的 SES 进行调整后，肺癌特异性生存率并不取决于城市化程度，但生存率随着人口普查区水平 SES 的降低而降低。对于年轻患者和局部肿瘤，非西班牙裔黑人和白人患者的生存率差异更大，并且随着人口普查区水平的 SES 的增加而增加。年轻患者和局部肿瘤的性别差异最大。结论 肺癌诊断后生存率的差异仍然存在，交叉模式表明护理的获取和质量存在差异。需要努力确保高危人群接受符合指南的治疗。