The Geographical Deprivation Index is Independently Associated With All-Cause Long-Term Mortality in Resectable Lung
Matteo Petroncini1, Alexandra Lucien1, Lorenzo Gherzi1
1Thoracic Surgery, Cochin Hospital, APHP Centre, University of Paris Cité, Paris, 75014, France.
Objectives:
We aimed at assessing the relationships between social deprivation and survival of resectable lung cancer.
Methods:
We performed (a) a nationwide study based on the Epithor project on patients undergoing surgery for lung cancer to assess the impact of the French Deprivation Index (FDI) of the department where surgery was performed on overall survival (OS); (b) an institutional study on consecutive patients referred to a single surgical centre to assess the impact of the FDI of the patients' department of residence on OS. Survival analyses were performed by Kaplan-Meier estimator, log-rank tests, and univariable and multivariable Cox analyses. For the national study, survival analysis was also adjusted for predicted mortality using a prognostic score validated in a previous Epithor study.
Results:
In the nationwide study, including 54 500 patients, higher FDI (more disadvantaged) of Department where surgery was performed was associated with shorter long-term OS with an unadjusted hazard ratio (HR) of 1.10 (95% CI, 1.08-1.11) per unit increase in the Index, and a HR adjusted on predicted mortality of 1.14 (1.13-1.15). In the institutional study including 864 patients, a higher FDI of the patient's department of residence was associated with shorter long-term OS, with an unadjusted HR of 1.17 (1.08-1.26) per unit increase in the index, and a HR adjusted on usual confounders of 1.12 (1.03-1.22). In both studies, there was no evidence of a non-linear association between the index and mortality.
Conclusions:
Strategies to reduce territorial inequalities seem necessary to improve the outcome of resectable lung cancer.
