Neighborhood Disadvantage and Lung Cancer Incidence in Ever-Smokers at a Safety-Net Healthcare System: A Retrospective Study.

BACKGROUND: Neighborhood circumstances have an influence on multiple health outcomes, but the association between neighborhood conditions and lung cancer incidence has not been studied in sufficient detail. We sought to understand whether neighborhood conditions are independently associated with lung cancer incidence in ever-smokers after adjusting for individual smoking exposure and other risk factors.

METHODS: A cohort of ever-smokers 55 years and older was assembled from 19 years of electronic health record data from our academic community healthcare system. Patient demographics and other measures known to be associated with lung cancer were ascertained. Patient addresses at their index visit were geocoded to the census block group level to determine the area deprivation index (ADI), drawn from 5-year estimates from the American Community Survey. A multivariate Cox-proportional hazard model was fit to assess the association between ADI and time to lung cancer diagnosis. Tests of statistical significance were two-sided.

RESULTS: The study included 19,867 males and 21,748 females. 53% of the patients were White, 38% were Black and 5% were Hispanic. Of these, 1,149 developed lung cancer. After adjusting for known risk factors, patients residing in the most disadvantaged areas had a significantly increased incidence of lung cancer as compared to those in the least disadvantaged areas (HR 1.29, 95% CI 1.07-1.55).

CONCLUSIONS: Census-derived estimates of neighborhood conditions have a powerful association with lung cancer incidence, even when adjusting for individual variables. Further work investigating the mechanisms that link neighborhood conditions to lung cancer is warranted.