{"entity":{"id":"paper-forrest-socioeconomic-inequalities-lung-cancer-treatment-plos-med-2013","kind":"paper","name":"Socioeconomic inequalities in lung cancer treatment: systematic review and meta-analysis","aka":[],"tldr":"Poorer patients with lung cancer are less likely to be given any treatment at all, and the gap is not explained by them being diagnosed later or by which country's health system they are in.","summary":"Forrest, Adams, Wareham, Rubin and White searched MEDLINE, EMBASE and Scopus to September 2012 for cohort studies in which receipt of lung cancer treatment was reported by a measure of socioeconomic position. Forty-six papers met the inclusion criteria and 23 entered the meta-analysis.\n\nThe framing matters as much as the result: the authors call this an intervention-generated inequality, a variation in outcome produced by how care is organised and delivered rather than by the disease. The gap survived adjustment for stage at presentation and was present across health care systems, including systems free at the point of use.","asOf":"2026-09-25","links":[{"label":"PLoS Med 2013","url":"https://doi.org/10.1371/journal.pmed.1001376"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/23393428/"}],"tags":["lung-evidence"],"related":["paper-uspstf-lung-cancer-screening-jama-2021","global-access-roadmap","idea-prev-mobile-lung-screening-deprived-areas"],"cancers":["lung-cancer","nsclc","sclc"],"sections":["early-detection"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["performance-status"],"trials":[],"people":[],"bottlenecks":["b-global-access","b-care-fragmentation","b-trial-diversity","b-workforce"],"keyPapers":[],"journals":["plos-medicine"],"dependsOn":[],"notes":[],"journal":"PLoS Medicine","year":2013,"doi":"10.1371/journal.pmed.1001376","pmid":"23393428","authors":"Forrest LF, Adams J, Wareham H, et al.","paperType":"meta-analysis","findings":["Lower socioeconomic position was associated with a reduced likelihood of receiving any treatment (odds ratio 0.79, 95 percent confidence interval 0.73 to 0.86).","Patients in more deprived circumstances were less likely to receive surgery and less likely to receive chemotherapy.","The inequalities were not accounted for by socioeconomic differences in stage at presentation or by differences in health care system.","46 papers met the inclusion criteria; 23 were included in the meta-analysis."],"whatItMeans":"The deprivation gradient in lung cancer is not only about who gets the disease. Among people who already have it, and at the same stage, poorer patients are less likely to be offered the treatment that works.","caveats":["Observational cohorts with heterogeneous measures of socioeconomic position, pooled; residual confounding by comorbidity and performance status cannot be excluded.","Literature to 2012, before immunotherapy and before most perioperative treatment; whether the gap has widened or narrowed since is untested here.","United Kingdom-specific figures, audit indicators and NHS pathway detail belong to the UK and NHS page for lung cancer."],"changedPractice":false},"route":"/key-papers/paper-forrest-socioeconomic-inequalities-lung-cancer-treatment-plos-med-2013/","neighbours":{"paper":[{"id":"paper-uspstf-lung-cancer-screening-jama-2021","kind":"paper","name":"Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement","route":"/key-papers/paper-uspstf-lung-cancer-screening-jama-2021/"}],"roadmap":[{"id":"global-access-roadmap","kind":"roadmap","name":"Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation","route":"/roadmaps/global-access-roadmap/"}],"idea":[{"id":"idea-lung-uk-screening-testing-and-access-gaps","kind":"idea","name":"Close the United Kingdom lung cancer gaps the UK page names: screening rollout, diagnostic pathway, molecular testing and drug access","route":"/ideas/idea-lung-uk-screening-testing-and-access-gaps/"},{"id":"idea-prev-mobile-lung-screening-deprived-areas","kind":"idea","name":"Take lung screening scanners to supermarket car parks in the poorest areas","route":"/ideas/idea-prev-mobile-lung-screening-deprived-areas/"},{"id":"idea-lung-deprivation-gradient-treated-as-a-defect-in-delivery","kind":"idea","name":"Treat the deprivation gradient in lung cancer as a defect in delivery that can be fixed and measured","route":"/ideas/idea-lung-deprivation-gradient-treated-as-a-defect-in-delivery/"}],"cancer":[{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"term":[{"id":"performance-status","kind":"term","name":"Performance status (ECOG, Karnofsky)","route":"/terms/performance-status/"}],"bottleneck":[{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"},{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-workforce","kind":"bottleneck","name":"Not enough oncologists, nurses, pathologists, physicists","route":"/bottlenecks/b-workforce/"},{"id":"b-trial-diversity","kind":"bottleneck","name":"Trials do not represent the people who get cancer","route":"/bottlenecks/b-trial-diversity/"}],"journal":[{"id":"plos-medicine","kind":"journal","name":"PLOS Medicine","route":"/journals/plos-medicine/"}]}}