Original article
General thoracic
Gender, Race, and Socioeconomic Status Affects Outcomes After Lung Cancer Resections in the United States

Presented at the Poster Session of the Forty-seventh Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2011.
https://doi.org/10.1016/j.athoracsur.2011.04.048Get rights and content

Background

The effect of gender, race, and socioeconomic status on contemporary outcomes after lung cancer resections has not been comprehensively evaluated across the United States. We hypothesized that risk-adjusted outcomes for lung cancer resections would not be influenced by these factors.

Methods

From 2003 to 2007, 129,207 patients undergoing lung cancer resections were evaluated using the Nationwide Inpatient Sample (NIS) database. Multiple regression analysis was used to estimate the effects of gender, race, and socioeconomic status on risk-adjusted outcomes.

Results

Average patient age was 66.8 ± 10.5 years. Women accounted for 5.0% of the total study population. Among racial groups, whites underwent the largest majority of operations (86.2%), followed by black (6.9%) and Hispanic (2.8%) races. Overall the incidence of mortality was 2.9%, postoperative complications were 30.4%, and pulmonary complications were 22.0%. Female gender, race, and mean income were all multivariate correlates of adjusted mortality and morbidity. Black patients incurred decreased risk-adjusted morbidity and mortality compared with white patients. Hispanics and Asians demonstrated decreased risk-adjusted complication rates. Importantly low income status independently increased the adjusted odds of mortality.

Conclusions

Female gender is associated with decreased mortality and morbidity after lung cancer resections. Complication rates are lower for black, Hispanic, and Asian patients. Low socioeconomic status increases the risk of in-hospital death. These factors should be considered during patient risk stratification for lung cancer resection.

Section snippets

Data Source

Data was obtained from the 2002 to 2007 Nationwide Inpatient Sample (NIS) datasets. NIS data represents the largest, all-payer, publicly available inpatient care database in the United States, providing a 20% random sample of US hospital discharges. The hospitals represented within these datasets are designated as “community hospitals” within the American Hospital Association annual survey. Data reported herein represents in-patient admissions for patients of all ages, races, income levels, and

Patient, Hospital, and Operative Characteristics

Descriptive statistics for select model covariates are presented in Table 1. Average patient age was 66.8 ± 10.5 years. Women accounted for 5.0% of the total study population. Among racial groups, whites underwent the large majority of operations (86.2%), followed by black (6.9%) and Hispanic (2.8%) races. The most frequent mean income quartile represented those earning more than $63,000 per year (mean income quartile IV). With respect to lung cancer resections, lobectomy was the most common

Comment

The present study reports on contemporary nationwide lung cancer resection outcomes in the United States as they relate to differences in gender, race, and socioeconomic status. These results suggest that after accounting for the potential confounding influence of more than 50 different variables, female gender was a significant, independent correlate of postoperative morbidity and mortality and was associated with reduced odds of death and postoperative complications compared with male gender.

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