Impact of socioeconomic determinants and clinical characteristics on non-small cell lung cancer survival: a real-world cohort study.

BACKGROUND: Data on clinical and socioeconomic factors affecting lung cancer survival in low-middle-income countries are limited. This study aims to explore the association between clinical, socioeconomic characteristics, and overall and cancer-specific survival in patients with lung cancer. METHODS: A retrospective cohort of 16,038 patients with non-small cell lung cancer diagnosed between January 2000 and December 2016, with follow-up until December 2022. Eligible individuals were >18 years old with a histologically confirmed diagnosis. Variables included sociodemographic factors, cancer staging, imaging technology and facility density. RESULTS: Independent predictors of all-cause mortality: gender, clinical stage, age, Human Development Index (HDI) 2010 {male vs. female [hazard ratio (HR) 1.27; 95% confidence interval (CI): 1.22-1.31; age, per 10-year increase (HR 1.07; 95% CI: 1.06-1.09); HDI 2010, per 0.1-unit increase (HR 0.98; 95% CI: 0.94-1.01)}. Advanced clinical stage is associated with increased overall mortality: stage IV (HR 4.58; 95% CI: 4.29-4.88), stage III (HR 2.90; 95% CI: 2.71-3.09), and stage II (HR 1.69; 95% CI: 1.55-1.85) compared to stage I. Independent predictors for cause-specific death: gender, clinical stage, age, HDI 2010 [male vs. female (HR 1.26; 95% CI: 1.21-1.31); age, per 10-year increment (HR 1.05; 95% CI: 1.04-1.07); HDI 2010, per 0.1-unit increase (HR 0.93; 95% CI: 0.90-0.97)]. Advanced clinical stages increased overall mortality risk: stage IV (HR 6.65; 95% CI: 6.14-7.19), stage III (HR 4.08; 95% CI: 3.76-4.43), and stage II (HR 2.25; 95% CI: 2.03-2.50) compared to stage I. CONCLUSIONS: Higher HDI score improves lung cancer survival in a middle-income country. Male gender, older age, and advanced stages predict poorer outcomes.