High neighborhood socioeconomic disadvantage was associated with increased odds of advanced-stage lung cancer at diagnosis by robotic-assisted bronchoscopy (OR 2.59; 95% CI 1.04-6.44; p=0.04).
Cohort (n=540)
Yes
Does neighborhood socioeconomic disadvantage predict the stage of lung cancer diagnosis in patients undergoing robotic-assisted bronchoscopy?
Higher neighborhood socioeconomic disadvantage is associated with a significantly higher likelihood of presenting with advanced-stage lung cancer at the time of robotic-assisted bronchoscopy.
Effect estimate: OR 2.59 (95% CI 1.04-6.44)
p-value: p=0.04
Abstract Rationale Socioeconomic disadvantage is associated with worse outcomes in lung cancer. Robotic-assisted bronchoscopy (RaB) is largely becoming the standard of care in peripheral lung nodule diagnostics. To date, no studies have characterized the impact of neighborhood socioeconomic status (SES) on diagnostic outcomes of RaB. Methods We performed a multi-center retrospective cohort study of patients who underwent RaB from September 2019 to February 2025 at one large tertiary academic center and two community hospitals. Neighborhood SES was characterized by the Area Deprivation Index (ADI), with higher ADI representing greater SES disadvantage. Patients were categorized into low, intermediate, and high ADI tertiles. ANOVA testing and Chi-square analyses were performed to investigate differences in nodule size and diagnostic result by ADI tertile. Multivariable logistic and linear regression were performed to analyze associations between ADI tertile, nodule size, malignant diagnosis, and staging, adjusting for age, sex, race, and smoking history. Results A total of 540 patients were included in the study (mean age 68.2±11.3 years, 58.1% female). Average ADI of the cohort was 41.7±16.4, median nodule size was 20.5 mm. RaB revealed malignancy in 263/540 (48.7%) patients, 51/263 (19.4%) of which were detected by coronary artery and lung cancer screening CTs. Average nodule size did not vary across race (p = 0.19) or ADI tertiles (p = 0.21). Rates of malignant diagnoses were similar across race (χ²=0.01, p = 0.9) and ADI tertiles (χ²=2.31, p = 0.31). When adjusted for age, sex, race, and smoking history, higher ADI was not associated with larger nodule size (β =-2.45, 95% CI -6.40-1.51, p = 0.22) or higher odds of malignant peripheral nodule diagnosis (OR = 1.10, 95% CI 0.65-1.86, p = 0.72). Among patients with RaB diagnoses of malignancy, staging differed significantly by ADI tertile but not race (Figure 1). Advanced-stage disease (Stage 2 or higher) was more frequent among patients in the intermediate and high ADI tertiles compared to those in the low tertile (χ²=7.37, p = 0.025), a difference that remained significant when adjusted for covariates (OR = 2.59, 95% CI 1.04-6.44 for high versus low ADI tertiles, p = 0.04). Conclusions In this multi-center retrospective cohort, which is the largest to date investigating the impact of neighborhood SES on RaB outcomes, nodule size and diagnostic yield of malignancy were comparable across ADI strata. However, cancer stage at diagnosis varied significantly with ADI tertile. Patients of higher socioeconomic disadvantage more likely to present with advanced-stage disease at time of RaB. This pattern may reflect barriers to healthcare access and delays in diagnostic evaluation. This abstract is funded by: None
Liu et al. (Fri,) conducted a cohort in Peripheral lung nodule (n=540). High Area Deprivation Index (ADI) tertile vs. Low ADI tertile was evaluated on Advanced-stage disease (Stage 2 or higher) (OR 2.59, 95% CI 1.04-6.44, p=0.04). High neighborhood socioeconomic disadvantage was associated with increased odds of advanced-stage lung cancer at diagnosis by robotic-assisted bronchoscopy (OR 2.59; 95% CI 1.04-6.44; p=0.04).