Educational level, management and outcomes in small-cell lung cancer (SCLC): a population-based cohort study

Abstract Objectives To examine if educational status is associated with outcome in patients with Small Cell Lung Cancer (SCLC). The study also investigated differences in patterns of management (lead times and treatment intensity) between educational levels. Material and methods This nationwide cohort study was based on data from Lung Cancer Data Base Sweden (LCBaSe) generated by record linkages between the Swedish National Lung Cancer Register and several other population-based registers. Educational level was categorized by number of years of schooling: low (≤ 9 years), medium (10–12 years) and high (≥ 13 years). Risk of death expressed as hazard ratios (HR) with 95 % confidence interval (CI) were estimated in multi-variable analyses adjusted for age, sex, disease stage at diagnosis, household size and performance status (PS). Analyses stratified by sex and stage were also performed. Results and conclusions The study population encompassed 4256 patients with an SCLC diagnosis between 2002 and 2011. Higher education was associated with a significantly lower risk of death in univariable and multivariable models. The univariable HR comparing high to low level of education was 0.84 (95 % CI: 0.75–0.93), an estimate that was attenuated following adjustments (HR 0.88; 95 % CI: 0.80–0.98). Compared to men with a low level of education, the risk of death was significantly lower in men with a high education; HR 0.84 (95 % CI: 0.73–0.98). In Limited Disease (LD), the prognosis was significantly better in both men and women with high compared low education (HR 0.76; 95 % CI: 0.58–0.98). In Swedish men with SCLC, and among patients with LD-SCLC, a low level of education was associated with a poorer prognosis compared to patients with high education.