Disparities in the Diagnosis and Treatment of Lung Cancer among People with Disabilities
- Authors
- Shin, Dong Wook; Cho, Jong Ho; Noh, Jae Myoung; Han, Hyesook; Han, Kyungdo; Park, Sang Hyun; Kim, So Young; Park, Jong Heon; Park, Jong Hyock; Kawachi, Ichiro
- Issue Date
- Feb-2019
- Publisher
- ELSEVIER SCIENCE INC
- Keywords
- Lung cancer; Disability; Stage; Treatment; Survival
- Citation
- JOURNAL OF THORACIC ONCOLOGY, v.14, no.2, pp.163 - 175
- Journal Title
- JOURNAL OF THORACIC ONCOLOGY
- Volume
- 14
- Number
- 2
- Start Page
- 163
- End Page
- 175
- URI
- http://scholarworks.bwise.kr/ssu/handle/2018.sw.ssu/39085
- DOI
- 10.1016/j.jtho.2018.10.158
- ISSN
- 1556-0864
- Abstract
- Introduction: Potential disparities in the diagnosis, treatment, and survival of patients with lung cancer with and without disabilities have rarely been investigated. Methods: We conducted a retrospective cohort study with a data set linking the Korean National Health Service database, disability registration data, and Korean Central Cancer Registry data. A total of 13,591 people with disabilities in whom lung cancer had been diagnosed and 43,809 age- and sex-matched control subjects in whom lung cancer had been diagnosed were included. Results: Unknown stage was more common in people with severe disabilities (13.1% versus 10.3%), especially those with a communication (14.2%) or mental/cognitive disability (15.7%). People with disabilities were less likely to undergo a surgical procedure (adjusted OR [aOR] = 0.82, 95% confidence interval [CI]: 0.77-0.86), chemotherapy (aOR = 0.80, 95% CI: 0.77-0.84), or radiotherapy (aOR = 0.92, 95% CI: 0.88-0.96). This higher likelihood wasmore evident for people with severe communication impairment (aORs of 0.46 for surgery and 0.64 for chemotherapy) and severe brain/mental impairment (aORs 0.39 for surgery, 0.47 for chemotherapy, and 0.49 for radiotherapy). Patients with disabilities had a slightly higher overall mortality than did people with no disability (adjusted hazard ratio = 1.08, 95% CI: 1.06-1.11), especially in the group with a severe disability (a hazard ratio = 1.20, 95% CI: 1.16-1.24). Conclusions: Patients with lung cancer and disabilities, especially severe ones, underwent less staging work-up and treatment even though their treatment outcomes were only slightly worse than those of people without a disability. Although some degree of disparity might be attributed to reasonable clinical judgement, unequal clinical care for people with communication and brain/mental disabilities suggests unjustifiable disability-related barriers that need to be addressed. (C) 2018 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.
- Files in This Item
- There are no files associated with this item.
- Appears in
Collections - ETC > 1. Journal Articles
Items in ScholarWorks are protected by copyright, with all rights reserved, unless otherwise indicated.