Disparities in Lung Cancer Care and Outcomes among Elderly in a Medically Underserved State Population—A Cancer Registry-Linked Database Study
- 1 April 2016
- journal article
- Published by Mary Ann Liebert Inc in Population Health Management
- Vol. 19 (2), 109-119
- https://doi.org/10.1089/pop.2015.0027
Abstract
Despite availability of guidelines for lung cancer care, variations in lung cancer care among the elderly exist across the nation and are a cause for concern in rural and medically underserved areas. Therefore, the purpose of this study was to evaluate the patterns of lung cancer care and associated health outcomes among elderly residing in a rural and medically underserved area. The authors identified 1924 elderly lung cancer patients from the West Virginia Cancer Registry-Medicare linked database (2002-2007) and categorized them by receipt of guideline-concordant (appropriate and timely) care using guidelines from the American College of Chest Physicians, British Thoracic Society, and the RAND Corporation. Hierarchical generalized logistic models were constructed to identify variables associated with receipt of guideline-concordant care. Kaplan-Meier analysis and log-rank test were used to compare 3-year survival outcomes. Multivariate Cox proportional hazards models were constructed to estimate lung cancer mortality risk associated with nonreceipt of guideline-concordant care. Although guideline-concordant appropriate care was received by fewer than half of all patients (46.5%), of those receiving care, 78.7% received it in a timely manner. Delays in diagnosis and treatment varied significantly. Survival outcomes significantly improved with appropriate care (799 vs. 366 days; P≤0.05), but did not improve with timely care. This study highlights the critical need to address disparities in receipt of guideline-concordant lung cancer care among the elderly residing in rural and medically underserved areas. Although lung cancer diagnostic and management services are covered under the Medicare program, underutilization of these services is a concern. (Population Health Management 2016;19:109-119).Keywords
This publication has 38 references indexed in Scilit:
- Factors associated with adherence to chemotherapy guidelines in patients with non-small cell lung cancerLung Cancer, 2012
- Lung Cancer Diagnostic and Treatment Intervals in the United States: A Health Care Disparity?Journal of Thoracic Oncology, 2009
- Timeliness of care in patients with lung cancer: a systematic reviewThorax, 2009
- Population Variations in the Initial Treatment of Non–Small-Cell Lung CancerJournal of Clinical Oncology, 2004
- Are rural residents less likely to obtain recommended preventive healthcare services?American Journal of Preventive Medicine, 2001
- Differences in initial treatment patterns and outcomes of lung cancer in the elderlyLung Cancer, 1995
- Presentation adapting a clinical comorbidity index for use with ICD-9-CM administrative data: Differing perspectivesJournal of Clinical Epidemiology, 1993
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databasesJournal of Clinical Epidemiology, 1992
- The Robust Inference for the Cox Proportional Hazards ModelJournal of the American Statistical Association, 1989
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987