Socioeconomic Factors Associated with Receipt of Minimally Invasive Surgery for NSCLC: Evidence from the National...

Lung cancer remains the leading cause of cancer-related morbidity and mortality. Despite advances in surgical management, economically disadvantaged patients experience inequalities in the receipt of treatments. We evaluated the association between socioeconomic status (SES) and type of surgery: robotic-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS), and open thoracotomy.

Data came from the National Cancer Database (2015-2022) and included Stage 0-IIIa NSCLC patients. SES was measured by quartiles of median household income in the patient's zip code. Adjusted multinomial logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Among 84,931 patients with a mean age of 67.8 years, 38.4% underwent open thoracotomy, 33.3% underwent VATS, and 28.2% underwent RATS. Patients residing in the low-income areas (<$46,277) were significantly less likely to undergo RATS (aOR: 0.79, 95% CI: 0.77-0.86) or VATS (aOR: 0.62, 95% CI: 0.59-0.66) compared to patients living in high-income areas (≥$74,063). Community hospitals were less likely to provide RATS (aOR: 0.32, 95% CI: 0.29-0.35) or VATS (aOR: 0.58, 95% CI: 0.54-0.63) than academic centers.

Socioeconomic disadvantage is associated with lower use of minimally invasive surgical approaches for NSCLC. Efforts to expand access to advanced surgical care may be necessary to reduce treatment disparities and improve outcomes.