Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb:188:107452.
doi: 10.1016/j.lungcan.2023.107452. Epub 2023 Dec 23.

The Effect of Social Vulnerability on Initial Stage and Treatment for Non-Small Cell Lung Cancer

Christina M Stuart  1 , Adam R Dyas  2 , Michael R Bronsert  3 , Catherine G Velopulos  2 , Simran K Randhawa  2 , Elizabeth A David  2 , John D Mitchell  2 , Robert A Meguid  2
Affiliations

The Effect of Social Vulnerability on Initial Stage and Treatment for Non-Small Cell Lung Cancer

Christina M Stuart et al. Lung Cancer. 2024 Feb.

Abstract

Objective: The Social Vulnerability Index (SVI) is a composite metric for social determinants of health. The objective of this study was to determine if SVI influences stage at presentation for non-small cell lung cancer (NSCLC) patients and subsequent therapies.

Materials and methods: NSCLC patients from our local contribution to the National Cancer Database (2011-2021) were grouped into low SVI (<75 %ile) and high SVI (>75 %ile) cohorts. Demographics, cancer-related variables, and treatment modalities were compared. Multivariable logistic regression was performed to control for the impact of demographics on cancer presentation and for the impact of oncologic variables on treatment outcomes.

Results: Of 1,662 NSCLC patients, 435 (26 %) were defined as high SVI. Compared to the 1,227 (74 %) low SVI patients, highly vulnerable patients were more likely to be male (53.3 % vs 46.0 %, p = 0.009), non-White (17.2 % vs 9.7 %, p < 0.0001), have comorbidities (29.4 % vs 23.1 %, p = 0.009) and present at a higher AJCC clinical T, M and overall stage (all p < 0.05). These findings persisted on multivariable analysis, with highly vulnerable patients having 1.5x the odds (95 %CI: 1.23-1.86, p < 0.001) of presenting at more advanced stage. Patients with high SVI were less likely to be recommended for and receive surgery (40.9 % vs 53.2 %, p < 0.001), and this finding persisted after controlling for stage at presentation (OR 1.37, 95 %CI 1.04-1.80).

Conclusions: Highly vulnerable patients present at a more advanced clinical stage and are less likely to be recommended and receive surgery, even after controlling for stage at presentation. Further investigation into these findings is warranted to achieve more equitable oncologic care.

Keywords: Non-small cell lung cancer; Social determinants of health; Social vulnerability index.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Christina M Stuart reports that this work was supported by the National Institutes of Health, under Ruth L. Kirschstein National Research Service Award T32CA17468.

Figures

Figure 1.
Figure 1.
Components of the Social Vulnerability Index and four themes.
Figure 2.
Figure 2.
Frequency distribution of overall social vulnerability index demonstrating bimodal distribution.
Figure 3.
Figure 3.
Consort diagram summarizing patient cohorts.
Figure 4.
Figure 4.
Percentage of NSCLC patients who present at various AJCC Clinical Stage by social vulnerability.
Figure 5.
Figure 5.
Percentage of NSCLC patients who present at various AJCC Clinical Stage stratified by the four subgroups of social vulnerability. The blue hashed area represents low vulnerability patients, and the red area represents highly vulnerable patients. Significant differences in distribution are noted by *.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Siegel RL, Miller KD, Fuchs HE et al. Cancer statistics, 2022. CA Cancer J Clin 2022; 72 (1): 7–33. - PubMed
    1. Elliott I, Gonzalez C, Backhus L et al. Social Disparities in Lung Cancer. Thorac Surg Clin 2022; 32 (1): 33–42. - PubMed
    1. (ATSDR). AfTSaDR. CDC’s Social Vulnerability Index (CVI) 2022.
    1. Azap RA, Paredes AZ, Diaz A et al. The association of neighborhood social vulnerability with surgical textbook outcomes among patients undergoing hepatopancreatic surgery. Surgery 2020; 168 (5): 868–875. - PubMed
    1. Stuart CM, Dyas AR, Byers S et al. Social Vulnerability is Associated with Increased Post-Operative Morbidity following Esophagectomy. J Thorac Cardiovasc Surg 2023. - PubMed

Publication types