Demographic and socioeconomic factors associated with stage at diagnosis in non–small cell lung cancer: An NCDB analysis.

9132 Background: There were 2.21 million new diagnoses of lung cancer worldwide in 2020, accounting for approximately 25% of all cancer related deaths. A factor that impacts the overall mortality of lung cancer is the stage at initial presentation for diagnosis. Current 5-year survival estimates of non-small cell (NSC) lung cancer range from 73% in early-stage disease to 13% in advanced disease. The stark differences in survival rate in early and late disease, highlight the importance of determining if socioeconomic and demographic factors impact the stage of cancer at diagnosis. This study sought to determine if certain socioeconomic and demographic factors are associated with receiving an early (Stage 0-I) or delayed (Stage IV) diagnosis of NSC lung cancer. Methods: Using the National Cancer Database, 1,149,539 patients were identified as having a NCDB Analytic Stage Group diagnosis of Stage 0-I (early) vs Stage IV (delayed/advanced) NSC lung cancer between 2004 and 2018. Using SPSS statistics 27, patients with early and delayed diagnoses were compared to each other based on certain characteristics including sex, race, ethnicity, and level of education. Results were analyzed using multivariate and chi square analyses, as well as one-way ANOVA. Results: We identified significant differences (p <.005) between stage at presentation and certain socioeconomic factors. Females were 70% less likely to be diagnosed with advanced disease in comparison to males (p <.001, 95% CI =.697-.708). African Americans and Native Americans were more likely to present with advanced disease in comparison to white patients (p <.001, 95% CI = 1.407-1.449 and 1.046 – 1.235, respectively). Hispanic patients were 49.3% more likely to present with advanced disease than non-Hispanic patients (p <.001, 95% CI = 1.389 – 1.605). Patients with at least one comorbidity (CCI score ≥ 1) were less likely to present with advanced disease (p <.001). Those who lived in a zip code where 21% or more of the residents lacked a high school degree were more likely to present with stage IV disease, in comparison to patients who lived in a zip code where less than 20.9% of its residents did not graduate from high school (p <.001). Conclusions: Demographic and socioeconomic factors associated with a delayed diagnosis of NSC lung cancer include male sex, non-white race, being Hispanic, having no comorbidities, and living in a zip code where 21% or more residents have no high school degree.