Routes to Diagnosis in Lung Cancer—Do Socio-Demographics Matter? An English Population-Based Study
Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Setting and Data Sources
2.2. Population
2.3. Outcome Variables
2.4. Explanatory Variables
2.5. Statistical Analyses
2.6. Ethics and Reporting
3. Results
3.1. Patient Characteristics
3.2. Analysis 1: Emergency Presentation vs. All Primary Care-Initiated Routes
3.3. Analysis 2: 2WW vs. Standard Primary Care-Initiated Routes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Characteristic | Number (%) |
---|---|
Deprivation 1 | |
1 (Least Deprived) | 25,302 (13.92) |
2 | 32,606 (17.94) |
3 | 36,234 (19.93) |
4 | 40,685 (22.38) |
5 (Most Deprived) | 46,936 (25.82) |
Sex | |
Male | 97,827 (53.82) |
Female | 83,936 (46.18) |
Age at Diagnosis (Years) | |
<50 | 4632 (2.55) |
50–59 | 16,772 (9.23) |
60–69 | 47,667 (26.22) |
70–79 | 63,050 (34.69) |
80–89 | 42,325 (23.29) |
90+ | 7317 (4.03) |
Ethnicity | |
White | 168,809 (92.87) |
Other Ethnic Group 2 | 6256 (3.44) |
Unknown 3 | 6698 (3.69) |
Rural/Urban Residence | |
Rural Village, Hamlet, and Isolated Dwellings | 14,231 (7.83) |
Rural Town and Fringe | 17,439 (9.59) |
Urban City and Town | 80,331 (44.20) |
Extensive Urban Area | 69,762 (38.38) |
Government Region | |
North West | 30,903 (17.00) |
North East | 13,301 (7.32) |
West Midlands | 18,661 (10.27) |
Yorkshire and the Humber | 21,535 (11.85) |
East Midlands | 15,654 (8.61) |
East of England | 18,765 (10.32) |
South East | 26,027 (14.32) |
South West | 17,738 (9.76) |
London | 19,179 (10.55) |
Stage at Diagnosis | |
I | 27,476 (15.12) |
II | 13,520 (7.44) |
III | 35,303 (19.42) |
IV | 88,363 (48.61) |
Unknown 4 | 17,101 (9.41) |
Histology | |
SCLC | 19,125 (10.52) |
NSCLC 5 | 157,214 (86.49) |
Other 6 | 5424 (2.98) |
Multiple Tumours 7 | |
No | 149,148 (82.06) |
Yes | 32,615 (17.94) |
Number of Comorbidities 8 | |
0 | 101,797 (56.01) |
1–2 | 56,059 (30.84) |
3+ | 23,907 (13.15) |
Discussed at MDT | |
Yes | 83,489 (45.93) |
No | 30,631 (16.85) |
Missing | 67,643 (37.21) |
Diagnosis Year | |
2012 | 36,067 (19.84) |
2013 | 36,157 (19.89) |
2014 | 36,506 (20.08) |
2015 | 36,516 (20.09) |
2016 | 36,517 (20.09) |
Diagnosis Route 9 | |
Emergency 10 | 64,045 (35.24) |
Standard GP Referral | 41,788 (22.99) |
Inpatient Elective | 2976 (1.64) |
Outpatient (Other) | 21,555 (11.86) |
2WW 11 | 51,399 (28.28) |
All Primary Care-Initiated Routes 12 | 117,718 (64.76) |
Standard Primary Care-Initiated Routes 13 | 66,319 (36.49) |
Analysis 1: Emergency Presentation vs. All Primary Care-Initiated Routes | Analysis 2: 2WW vs. Standard Primary Care-Initiated Routes | |||
---|---|---|---|---|
Emergency Presentation 1 n = 64,045 (35.24%) | All Primary Care-Initiated Routes 2 n = 117,718 (64.76%) | 2WW 3 n = 51,399 (43.66%) | Standard Primary Care-Initiated Routes 4 n = 66,319 (56.34%) | |
Deprivation 4,5 | ||||
1 (Least Deprived) | 8193 (32.38) | 17,109 (67.62) | 7234 (42.28) | 9875 (57.72) |
2 | 10,976 (33.66) | 21,630 (66.34) | 9569 (44.24) | 12,061 (55.76) |
3 | 12,751 (35.19) | 23,483 (64.81) | 10,300 (43.86) | 13,183 (56.14) |
4 | 14,816 (36.42) | 25,869 (63.58) | 11,476 (44.36) | 14,393 (55.64) |
5 (Most Deprived) | 17,309 (36.88) | 29,627 (63.12) | 12,820 (43.27) | 16,807 (56.73) |
Sex | ||||
Male | 34,022 (34.78) | 63,805 (65.22) | 27,805 (43.58) | 36,000 (56.42) |
Female | 30,023 (35.77) | 53,913 (64.23) | 23,594 (43.76) | 30,319 (56.24) |
Age at Diagnosis (Years) | ||||
<50 | 1471 (31.76) | 3161 (68.24) | 1276 (40.37) | 1885 (59.63) |
50–59 | 4896 (29.19) | 11,876 (70.81) | 5367 (45.19) | 6509 (54.81) |
60–69 | 13,466 (28.25) | 34,201 (71.75) | 15,574 (45.54) | 18,627 (54.46) |
70–79 | 20,487 (32.49) | 42,563 (67.51) | 18,333 (43.07) | 24,230 (56.93) |
80–89 | 19,147 (45.24) | 23,178 (54.76) | 9708 (41.88) | 13,470 (58.12) |
90+ | 4578 (62.57) | 2739 (37.43) | 1141 (41.66) | 1598 (58.34) |
Ethnicity | ||||
White | 58,809 (34.84) | 110,000 (65.16) | 48,528 (44.12) | 61,472 (55.88) |
Other Ethnic Group 6 | 2300 (36.76) | 3956 (63.24) | 1396 (35.29) | 2560 (64.71) |
Unknown 7 | 2936 (43.83) | 3762 (56.17) | 1475 (39.21) | 2287 (60.79) |
Rural/Urban Residence | ||||
Rural Village, Hamlet, and Isolated Dwellings | 4478 (31.47) | 9753 (68.53) | 4361 (44.71) | 5392 (55.29) |
Rural Town and Fringe | 5920 (33.95) | 11,519 (66.05) | 5248 (45.56) | 6271 (54.44) |
Urban City and Town | 27,978 (34.83) | 52,353 (65.17) | 24,321 (46.46) | 28,032 (53.54) |
Extensive Urban Area | 25,669 (36.80) | 44,093 (63.20) | 17,469 (39.62) | 26,624 (60.38) |
Government Region 8 | ||||
North West | 10,395 (33.64) | 20,508 (66.36) | - | - |
North East | 4640 (34.88) | 8661 (65.12) | - | - |
West Midlands | 6642 (35.59) | 12,019 (64.41) | - | - |
Yorkshire and the Humber | 7803 (36.23) | 13,732 (63.77) | - | - |
East Midlands | 5559 (35.51) | 10,095 (64.49) | - | - |
East of England | 6386 (34.03) | 12,379 (65.97) | - | - |
South East | 8892 (34.16) | 17,135 (65.84) | - | - |
South West | 6091 (34.34) | 11,647 (65.66) | - | - |
London | 7637 (39.82) | 11,542 (60.18) | - | - |
Analysis 1: Emergency Presentation vs. All Primary Care-Initiated Routes 1 | Analysis 2: 2WW Pathway vs. All Other Standard Primary Care-Initiated Routes 2 | |||
---|---|---|---|---|
mvOR | 95% CI | mvOR | 95% CI | |
Deprivation 3 | ||||
1 (Least Deprived) | 1.00 | - | 1.00 | - |
2 | 1.07 | 1.03–1.11 | 1.08 | 1.04–1.13 |
3 | 1.15 | 1.11–1.19 | 1.08 | 1.04–1.12 |
4 | 1.22 | 1.18–1.27 | 1.13 | 1.08–1.17 |
5 (Most Deprived) | 1.29 | 1.25–1.34 | 1.13 | 1.08–1.17 |
Sex | ||||
Male | 1.00 | - | 1.00 | - |
Female | 1.03 | 1.01– 1.05 | 1.00 | 0.98–1.03 |
Age at Diagnosis (Years) | ||||
<50 | 0.93 | 0.87–0.99 | 0.92 | 0.85–0.99 |
50–59 | 0.83 | 0.80–0.87 | 1.10 | 1.05–1.14 |
60–69 | 0.81 | 0.79–0.83 | 1.10 | 1.07–1.13 |
70–79 | 1.00 | - | 1.00 | - |
80–89 | 1.73 | 1.68–1.77 | 0.95 | 0.92–0.98 |
90+ | 3.49 | 3.32–3.67 | 0.95 | 0.87–1.02 |
Ethnicity | ||||
White | 1.00 | - | 1.00 | - |
Other Ethnic Group 4 | 1.05 | 0.99–1.11 | 0.74 | 0.70–0.80 |
Unknown 5 | 1.40 | 1.33–1.48 | 0.81 | 0.75–0.86 |
Rural/Urban Residence | ||||
Rural Village, Hamlet, and Isolated Dwellings | 0.90 | 0.86–0.94 | 1.27 | 1.21–1.33 |
Rural Town and Fringe | 0.94 | 0.91–0.98 | 1.29 | 1.24–1.35 |
Urban City and Town | 0.97 | 0.95–1.00 | 1.33 | 1.29–1.36 |
Extensive Urban Area | 1.00 | - | 1.00 | - |
Government Region | ||||
North West | 1.00 | - | - | - |
North East | 1.04 | 1.00–1.09 | - | - |
West Midlands | 1.10 | 1.05–1.14 | - | - |
Yorkshire and the Humber | 1.13 | 1.09–1.17 | - | - |
East Midlands | 1.13 | 1.08–1.18 | - | - |
East of England | 1.06 | 1.02–1.10 | - | - |
South East | 1.06 | 1.02–1.10 | - | - |
South West | 1.07 | 1.03–1.12 | - | - |
London | 1.27 | 1.22–1.32 | - | - |
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Norris, R.P.; Fuller, E.; Greystoke, A.; Todd, A.; Sharp, L. Routes to Diagnosis in Lung Cancer—Do Socio-Demographics Matter? An English Population-Based Study. Cancers 2025, 17, 1874. https://doi.org/10.3390/cancers17111874
Norris RP, Fuller E, Greystoke A, Todd A, Sharp L. Routes to Diagnosis in Lung Cancer—Do Socio-Demographics Matter? An English Population-Based Study. Cancers. 2025; 17(11):1874. https://doi.org/10.3390/cancers17111874
Chicago/Turabian StyleNorris, Ruth P., Elizabeth Fuller, Alastair Greystoke, Adam Todd, and Linda Sharp. 2025. "Routes to Diagnosis in Lung Cancer—Do Socio-Demographics Matter? An English Population-Based Study" Cancers 17, no. 11: 1874. https://doi.org/10.3390/cancers17111874
APA StyleNorris, R. P., Fuller, E., Greystoke, A., Todd, A., & Sharp, L. (2025). Routes to Diagnosis in Lung Cancer—Do Socio-Demographics Matter? An English Population-Based Study. Cancers, 17(11), 1874. https://doi.org/10.3390/cancers17111874