Individuals of low socioeconomic status who reside in disadvantaged neighborhoods with poor living conditions may be at higher risk for lung cancer, according to study results published in CHEST.
This retrospective chart review used electronic health record (EHR) data that spanned 19 years, from 1999 to 2018, from an urban safety-net healthcare system in Cleveland, Ohio. The cohort included in the review consisted of ever-smokers aged ≥55 years with no prior lung cancer diagnosis recorded in the EHR. Researchers obtained data regarding patient demographics, social and medical history, smoking status, smoking intensity and duration, as well as other measures associated with lung cancer.
A total of 19,867 men and 21,748 women were included in the study. To determine the area deprivation index (ADI), an established neighborhood-level socioeconomic position metric, the researchers mapped and geocoded patient addresses at their index visit to the census block group level. Living conditions and socioeconomic position in neighborhoods were included in the study’s composite ADI.
A total of 1149 patients in the retrospective cohort developed lung cancer during the 19-year period. Patients lived in 2166 census block groups in 45 counties in Ohio and the range in ADI values was 7.45 to 174.5. A median ADI of 141.4 was noted in 10,069 patients who lived in the top 10% of the most deprived neighborhoods. In a multivariable adjusted Cox analysis, individuals living in the most disadvantaged neighborhoods (highest 91%-100% percentiles of census block groups) had the greatest increased lung cancer incidence vs individuals who lived in the least disadvantaged neighborhoods (adjusted hazard ratio [aHR], 1.29; 95% CI, 1.07-1.55).
The incidence of lung cancer was significantly associated with smoking status (current: aHR, 1.44; 95% CI, 1.24-1.68), smoking intensity (packs per day; aHR, 2.02; 95% CI, 1.67-2.45), smoking duration (per 10-year increase; aHR, 1.22; 95% CI, 1.16-1.29), quit time (per 1-year increase; aHR, 0.98; 95% CI, 0.97-0.99), age (per 10-year increase; aHR, 1.40; 95% CI, 1.26-1.54), body mass index (per 5 kg/m2 increase; aHR, 0.85; 95% CI, 0.81-0.89), chronic obstructive pulmonary disease diagnosis (aHR, 1.97; 95% CI, 1.73-2.24), and personal history of cancer (aHR, 1.43; 95% CI, 1.26-1.62).
Study limitations included the reliance on EHR data, particularly since these data often inaccurately report and underestimate patient smoking exposure, and the inclusion of only patients from a single academic safety-net healthcare system in Ohio, which may limit generalizability of the findings.
The investigators concluded that additional research is needed “to more precisely elucidate the mechanisms by which area-based deprivation adversely impacts individual health as it pertains to lung cancer risk.”
Adie Y, Kats DJ, Tlimat A, et al. Neighborhood disadvantage and lung cancer incidence in ever-smokers at a safety-net healthcare system: a retrospective study [published online December 17, 2019]. CHEST. doi:10.1016/j.chest.2019.11.033