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Comorbidity and stage at diagnosis among lung cancer patients in the US military health system

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Abstract

Purpose

We investigated the association between comorbidities and stage at diagnosis among NSCLC patients in the US Military Health System (MHS), which provides universal health care to its beneficiaries.

Methods

The linked data from the Department of Defense’s Central Cancer Registry (CCR) and the MHS Data Repository (MDR) were used. The study included 4768 patients with histologically confirmed primary NSCLC. Comorbid conditions were extracted from the MDR data. Comorbid conditions were those included in the Charlson Comorbidity Index (CCI) and were defined as a diagnosis during a 3-year time frame prior to the NSCLC diagnosis. Multivariable logistic regression was performed to estimate odds ratios (ORs) and 95% confidence intervals (95% CI) of late stage (stages III and IV) versus early stage (stages I and II) in relation to pre-existing comorbidities.

Results

Compared to patients with no comorbidities, those with prior comorbidities tended to be less likely to have lung cancer diagnosed at late stage. When specific comorbidities were analyzed, decreased odds of being diagnosed at late stage were observed among those with chronic obstructive pulmonary disease (COPD) (adjusted OR 0.78, 95% CI 0.68 to 0.90). In contrast, patients with a congestive heart failure or a liver cirrhosis/chronic hepatitis had an increased likelihood of being diagnosed at late stage (adjusted OR 1.30, 95% CI 1.00 to 1.69 and adjusted OR 1.87, 95% CI 1.24 to 2.82, respectively).

Conclusions

Among NSCLC patients in an equal access health system, the likelihood of late stage at diagnosis differed by specific comorbid diseases.

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Acknowledgments

The original data linkage was supported by the United States Military Cancer Institute and Division of Cancer Epidemiology and Genetics, National Cancer Institute. This work was supported by John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences under the auspices of the Henry M. Jackson Foundation for the Advancement of Military Medicine and by the intramural research program of the National Cancer Institute.

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Authors and Affiliations

  1. John P. Murtha Cancer Center Research Program, Uniformed Service University of the Health Sciences and Walter Reed National Military Medical Center, 6720A Rockledge Drive, Suite 310, Bethesda, MD, 20817, USA

    Jie Lin, Joel A. Nations, Craig D. Shriver & Kangmin Zhu

  2. Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD, 20814, USA

    Jie Lin, Craig D. Shriver & Kangmin Zhu

  3. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892, USA

    Katherine A. McGlynn

  4. Department of Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Bethesda, MD, 20814, USA

    Kangmin Zhu

  5. Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA

    Jie Lin & Kangmin Zhu

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  1. Jie Lin
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  2. Katherine A. McGlynn
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  3. Joel A. Nations
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  4. Craig D. Shriver
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Correspondence to Jie Lin or Kangmin Zhu.

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Lin, J., McGlynn, K.A., Nations, J.A. et al. Comorbidity and stage at diagnosis among lung cancer patients in the US military health system. Cancer Causes Control 31, 255–261 (2020). https://doi.org/10.1007/s10552-020-01269-1

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  • DOI: https://doi.org/10.1007/s10552-020-01269-1

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