Gender disparities in lung cancer survival from an enriched Florida population-based cancer registry

Adel Elkbuli; Margaret M Byrne; Wei Zhao; Mason Sutherland; Mark McKenney; Yeissen Godinez; Devina J Dave; Layla Bouzoubaa; Tulay Koru-Sengul

doi:10.1016/j.amsu.2020.11.081

Gender disparities in lung cancer survival from an enriched Florida population-based cancer registry

Ann Med Surg (Lond). 2020 Dec 1:60:680-685. doi: 10.1016/j.amsu.2020.11.081. eCollection 2020 Dec.

Authors

Adel Elkbuli^{1

2}, Margaret M Byrne^{1

3}, Wei Zhao³, Mason Sutherland², Mark McKenney^{2

4}, Yeissen Godinez⁵, Devina J Dave¹, Layla Bouzoubaa^{1

3}, Tulay Koru-Sengul^{1

3}

Affiliations

¹ Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120, NW 14Street, Don Soffer Clinical Research Center, Miami, FL, 33136, USA.
² Department of Surgery, Kendall Regional Medical Center, 11750 SW 40th St, Miami, FL, 33175, USA.
³ Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, 33136, USA.
⁴ Department of Surgery, University of South Florida, Tampa, FL, USA.
⁵ Department of Internal Medicine, Kendall Regional Medical Center, 11750 SW 40th St, Miami, FL, 33175, USA.

Abstract

Background: Previous studies have revealed gender disparities in lung cancer survivorship, but comprehensive inclusion of clinical/individual variables which affect outcomes is underreported. We utilized the Florida Data Cancer System (FCDS) to examine associations between gender and lung cancer survivorship while controlling for prognostic variables on a large population-based scale.

Methods: A retrospective cohort analysis utilizing the FCDS, linked to Florida Agency for Health Care Administration and US Census Bureau tracts for patients diagnosed with primary lung cancer (n = 165,465) from 1996 to 2007. Primary outcome measures included median survival time and mortality. Multivariable Cox regression models, independent sample T-tests, and descriptive statistics were utilized with significance defined as p < 0.05.

Results: 165,465 cases were analyzed revealing 44.3% females and 55.7% males. The majority of patients were white/Caucasian, males, middle-high socioeconomic status, lived in urban areas, and geriatric age. Females had longer median survival compared to males (9.6 vs 7.1 months). Multivariable analyses showed that women had better survival after controlling for sociodemographic, clinical, and comorbidity covariates. Males had higher risk of mortality than females (aHR = 1.17, 95%CI 1.14-1.19, p < 0.01).

Conclusions: Individuals of higher socioeconomic status experienced greater survivorship compared to those of lower socioeconomic status. Women experienced significantly better survival for lung cancer at multiple time frames after controlling for covariates compared to men. Interventions aimed at public education and access to high-quality healthcare are needed to ameliorate socioeconomic and gender-based disparities in lung cancer survivorship. Future studies should investigate gender differences in lung cancer while incorporating individual socioeconomic status and treatment received.

Keywords: Gender disparity; Health inequalities; Healthcare access; Lung cancer survival; Socioeconomic status.