BACKGROUND Although counties are the smallest geographic level for comprehensive health-care delivery analysis, little is known about county-level variations in receipt of curative-intent surgery for early-stage non-small cell lung cancer (NSCLC) and factors contributing to such variations in the United States. METHODS A total of 179,189 patients aged ≥ 35 years who were diagnosed with stage I to II NSCLC between 2007 and 2014 in 2,263 counties were identified from 39 states, the District of Columbia, and Detroit population-based cancer registries; the data were compiled by the North American Association of Central Cancer Registries. The percentage of patients who underwent surgery was calculated for each county with ≥ 20 cases. Adjusted risk ratios were generated by using generalized estimating equation models with modified Poisson regression. RESULTS Receipt of surgery for early-stage NSCLC during 2007 to 2014 according to county ranged from 12.8% to 48.6% in the lowest decile of counties, to 74.3% to 91.7% in the highest decile of counties. There were pockets of low surgery receipt rate counties within each state. For example, there was a 25% absolute difference between the lowest and highest surgery receipt rate counties in Massachusetts. Counties in the lowest quartile for receipt of surgery were those with a high proportion of non-Hispanic black subjects, high poverty and uninsured rates, low surgeon-to-population ratio, and nonmetropolitan status. CONCLUSIONS Receipt of curative-intent surgery for early-stage NSCLC varied substantially across counties in the United States, with pockets of low receipt counties in each state. Low surgery receipt counties were characterized by unfavorable area-level socioeconomic and health-care delivery factors.

中文翻译：

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美国早期非小细胞肺癌接受手术的县级差异

背景 尽管县是综合医疗保健提供分析的最小地理级别，但对早期非小细胞肺癌 (NSCLC) 接受治愈性手术的县级差异以及导致此类差异的因素知之甚少。在美国。方法 在 2007 年至 2014 年间，从 39 个州、哥伦比亚特区和底特律人口癌症登记处确定了 2263 个县的 179189 名年龄≥35 岁且被诊断为 I 至 II 期 NSCLC 的患者；数据由北美中央癌症登记协会汇编。对≥20例的每个县计算接受手术的患者百分比。调整后的风险比是通过使用广义估计方程模型和修正泊松回归生成的。结果 2007-2014 年间接受手术的早期非小细胞肺癌按县划分，最低十分位数为 12.8% 至 48.6%，最高十分位数为 74.3% 至 91.7%。每个州都有一些手术接收率低的县。例如，马萨诸塞州最低和最高手术接收率县之间的绝对差异为 25%。接受手术率最低的县是那些非西班牙裔黑人受试者比例高、贫困率和无保险率高、外科医生与人口比例低以及非大都市地位的县。结论 早期 NSCLC 的治愈性手术接受率在美国各县之间差异很大，每个州都有一些低接受率县。