WCLC 2025 - Posters & ePosters-P3.01.07 Socioeconomic Inequalities and Lung Cancer Outcomes: Evidence From an Integrated EHR Database and State Cancer Registry Data

P3.01.07 Socioeconomic Inequalities and Lung Cancer Outcomes: Evidence From an Integrated EHR Database and State Cancer Registry Data

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This study investigates the impact of neighborhood-level socioeconomic inequalities on lung cancer (LC) survivors, focusing on risks of second primary lung cancer (SPLC) and LC mortality. Utilizing data from 35,499 patients diagnosed with initial primary lung cancer (IPLC) between 2009 and 2022, the research integrates electronic health records from Stanford Health Care and Sutter Health with the California Cancer Registry, tracking outcomes over up to 10 years.<br /><br />The main exposure examined is the neighborhood social determinants of health (nSDOH), particularly education segregation at the census-tract level, defined as the segregation between populations with high education (≥4-year degree) and low education (≤12 years). Statistical analyses include cause-specific Cox regression for SPLC risk, Cox regression for LC mortality considering SPLC diagnosis as a time-varying covariate, and mediation analysis to discrimate direct and indirect effects through SPLC.<br /><br />Key findings show that higher education segregation significantly increases the risk of both SPLC (adjusted hazard ratio [aHR] 1.28, 95% CI 1.22-1.35) and LC mortality (aHR 1.50, 95% CI 1.41-1.59). SPLC diagnosis itself is strongly associated with increased LC mortality (aHR 1.84, 95% CI 1.74-1.93). Mediation analysis reveals that 28% of the effect of education segregation on LC mortality is mediated by SPLC, with the remaining 72% a direct effect.<br /><br />The study underscores that LC survivors living in neighborhoods with greater educational segregation—reflecting socioeconomic disparities—are at higher risk of SPLC and death, independent of demographic and clinical factors. These findings highlight the critical need to address neighborhood-level socioeconomic inequalities to improve long-term outcomes among LC survivors.<br /><br />This research is supported by grants from the National Institutes of Health and the Canadian Institute for Health Research.

Asset Subtitle

Tae Yoon Lee

Meta Tag

Speaker Tae Yoon Lee

Topic Risk Factors, Risk Reduction & Tobacco Control

Keywords

lung cancer survivors

second primary lung cancer

lung cancer mortality

neighborhood socioeconomic inequalities

education segregation

social determinants of health

California Cancer Registry

Cox regression analysis

mediation analysis

health disparities