Comparison of Healthcare Utilization Before Diagnosis Between Non-Advanced and Advanced Lung Cancer Patients: A Study Among 72,851 Cases in Germany.

There is no study from Germany on the association between stage of lung cancer (LC) and patient characteristics. We aimed to compare advanced versus non-advanced LC cases regarding indicators of healthcare utilization. Using claims data covering 20% of the German population, we included LC patients diagnosed between 2013 and 2019. Stratified by stage (advanced vs. non-advanced), we assessed comorbidities, hospitalizations, outpatient physician contacts and utilization of preventive measures before LC diagnosis. Among 72,851 included LC patients, 29% (females) and 28% (males) were classified as non-advanced. For all comorbidities considered and for most other indicators, an inverse association with stage was observed. For example, in males with non-advanced versus advanced LC, the proportions with chronic obstructive pulmonary disease were 37% and 27% (females: 38% vs. 29%), and the proportions with ≥ 1 hospitalization in the 3 years prior LC diagnosis were 70% versus 58% (females: 69% vs. 55%). In conclusion, LC patients with more frequent healthcare utilization before LC diagnosis were more likely to be diagnosed at a non-advanced stage. Regarding future LC screening, the findings underline the importance of developing implementation strategies that ensure the reach of those who use health services less frequently, as these individuals are at higher risk of being diagnosed at an advanced stage if they develop LC.