BACKGROUND Neighborhood circumstances have an influence on multiple health outcomes, but the association between neighborhood conditions and lung cancer incidence has not been studied in sufficient detail. We sought to understand whether neighborhood conditions are independently associated with lung cancer incidence in ever-smokers after adjusting for individual smoking exposure and other risk factors. METHODS A cohort of ever-smokers 55 years and older was assembled from 19 years of electronic health record data from our academic community healthcare system. Patient demographics and other measures known to be associated with lung cancer were ascertained. Patient addresses at their index visit were geocoded to the census block group level to determine the area deprivation index (ADI), drawn from 5-year estimates from the American Community Survey. A multivariate Cox-proportional hazard model was fit to assess the association between ADI and time to lung cancer diagnosis. Tests of statistical significance were two-sided. RESULTS The study included 19,867 males and 21,748 females. 53% of the patients were White, 38% were Black and 5% were Hispanic. Of these, 1,149 developed lung cancer. After adjusting for known risk factors, patients residing in the most disadvantaged areas had a significantly increased incidence of lung cancer as compared to those in the least disadvantaged areas (HR 1.29, 95% CI 1.07-1.55). CONCLUSIONS Census-derived estimates of neighborhood conditions have a powerful association with lung cancer incidence, even when adjusting for individual variables. Further work investigating the mechanisms that link neighborhood conditions to lung cancer is warranted.

中文翻译：

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安全网医疗系统中的社区劣势与曾经吸烟者的肺癌发病率：一项回顾性研究


背景邻里环境对多种健康结果有影响，但邻里环境与肺癌发病率之间的关联尚未得到足够详细的研究。在调整个人吸烟暴露和其他危险因素后，我们试图了解社区状况是否与曾经吸烟者的肺癌发病率独立相关。方法 根据我们学术界医疗保健系统 19 年的电子健康记录数据收集了一组 55 岁及以上的曾经吸烟者。确定了患者人口统计数据和已知与肺癌相关的其他指标。患者在索引访视时的地址被地理编码到人口普查区块组级别，以确定区域剥夺指数 (ADI)，该指数根据美国社区调查的 5 年估计得出。多变量 Cox 比例风险模型适合评估 ADI 与肺癌诊断时间之间的关联。统计显着性检验是双向的。结果 该研究包括 19,867 名男性和 21,748 名女性。 53% 的患者是白人，38% 是黑人，5% 是西班牙裔。其中，1,149 人罹患肺癌。在调整已知的危险因素后，与最贫困地区的患者相比，居住在最贫困地区的患者肺癌发病率显着增加（HR 1.29，95% CI 1.07-1.55）。结论 即使在调整个别变量时，人口普查得出的邻里状况估计与肺癌发病率也有很强的相关性。有必要进一步研究将社区状况与肺癌联系起来的机制。