Regional disparities in treatment and survival of early stage non-small cell lung cancer.

Objectives: Recently, disparities related to ethnicity and rural place of residence for initial treatment and mortality of non-small cell lung cancer (NSCLC) have been reported. As a large proportion of residents in New Mexico are either Hispanic or reside in rural areas, we hypothesized that mortality of patients with early stage NSCLC would be higher in New Mexico compared to other areas of the country.
Methods: We used the Surveillance, Epidemiology, and End Results (SEER) Program registry to compare mortality from Stages 1A-2B NSCLC in New Mexico to other SEER registries between 1988-1997, and determined whether differences were related to demographics, tumor stage, place of residence, ethnicity, or receipt of surgical treatment. Data was collected from nine SEER registries functioning during the entire targeted period of 1988-1997.
Results: Cases in the New Mexico Registry had a greater mortality risk (adjusted HR 1.22, CI 1.12-1.32) compared to cases enrolled in the other SEER registries. This higher risk was related to less cancer-directed surgery in New Mexico SEER patients, and a shift toward greater proportions of elderly and Stage 1B cases in New Mexico. Rural Stage 1B cases also exhibited greater risk than urban cases. Ethnic differences did not contribute to the higher mortality risk observed in New Mexico cases, although rural Hispanics had a higher mortality risk than urban Hispanics.
Conclusions: These findings suggest a regional disparity in treatment and mortality risk for early stage NSCLC in New Mexico compared to the rest of the country.