Survival inequalities in patients with lung cancer in France: A nationwide cohort study (the TERRITOIRE Study)

PLoS One. 2017 Aug 25;12(8):e0182798. doi: 10.1371/journal.pone.0182798. eCollection 2017.

Abstract

The French healthcare system is a universal healthcare system with no financial barrier to access to health services and cancer drugs. The objective of the study is to investigate associations between, on the one hand, incidence and survival of patients diagnosed with lung cancer in France and, on the other, the socioeconomic deprivation and population density of their municipality of residence. A national, longitudinal analysis using data from the French National Hospital database crossed with the population density of the municipality and a social deprivation index based on census data aggregated at the municipality level. For lung cancer diagnosed at the metastatic stage, one-year and two-year survival was not associated with the population density of the municipality of residence. In contrast, mortality was higher for people living in very deprived, deprived and privileged areas compared to very privileged areas (hazard ratios at two years: 1.19 [1.13-1.25], 1.14 [1.08-1.20] and 1.10 [1.04-1.16] respectively). Similar associations are also observed in patients diagnosed with non-metastatic disease (hazard ratios at two years: 1.21 [1.13-1.30], 1.15 [1.08-1.23] and 1.10 [1.03-1.18] for people living in very deprived, deprived and privileged areas compared to very privileged areas). Despite a universal healthcare coverage, survival inequalities in patients with lung cancer can be observed in France with respect to certain socioeconomic indicators.

MeSH terms

  • France
  • Humans
  • Lung Neoplasms / pathology*
  • Retrospective Studies
  • Survival Analysis*

Grants and funding

This study was funded by Bristol-Myers Squibb (BMS), a company which markets pharmaceuticals used in the treatment of lung cancer. AF Gaudin, N Ozan and FE Cotté are salaried employees of BMS. BMS contracted the data analysis for this study to HEVA, a contract research organisation. C Blein, S Leblanc and A Vainchtock are employees or shareholders of HEVA. BMS have funded editorial support in the form of preparation of slide sets or posters for presentations of data from the TERRITOIRE study on behalf of CC, IDZ and PJS, as well as editorial support for the preparation of this manuscript. The funders initiated, designed and supervised the study.