Disparities in the Diagnosis and Treatment of Lung Cancer among People with Disabilities.

Published on Feb 1, 2019in Journal of Thoracic Oncology13.357
· DOI :10.1016/J.JTHO.2018.10.158
Dong Wook Shin26
Estimated H-index: 26
(SKKU: Sungkyunkwan University),
Jong Ho Cho17
Estimated H-index: 17
(SMC: Samsung Medical Center)
+ 7 AuthorsIchiro Kawachi173
Estimated H-index: 173
(Harvard University)
Sources
Abstract
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 was more 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.
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