Social Vulnerability is Associated with Significant Delays to Definitive Surgery for Stages IA to IIIA Non-small Cell Lung Cancer and Consequential Increased Rates of Pathologic Upstaging.

[BACKGROUND] Timely surgical resection is an important component of treatment for non-small cell lung cancer (NSCLC). The Social Vulnerability Index (SVI) is a validated, composite metric for social determinants of health. This study aimed to determine whether social vulnerability is associated with delayed surgery for NSCLC.

[METHODS] The study identified patients with stages IA to IIIA NSCLC who underwent upfront surgery between 2011 and 2021 in a single health care system. High social vulnerability was defined as SVI ≥ 75th percentile. Delayed surgery was defined as longer than 9 weeks after diagnosis. Unadjusted and risk-adjusted predictors of delayed surgery were identified. Time to surgery also was analyzed as a continuous variable. A negative binomial model was fitted to assess the individual impact of social vulnerability on time to surgery in days.

[RESULTS] Of 595 patients, 120 (20 %) had high social vulnerability. A greater proportion of vulnerable patients experienced surgical delay (32 % vs 16 %; p < 0.001) and had a significantly longer time to surgery (median, 49 days [interquartile range {IQR}, 19-84 days] vs 32 days [IQR, 0-57 days]; p < 0.001). After risk adjustment, high social vulnerability was associated with 2.3 times higher odds of surgical delay (95 % confidence interval [CI], 1.4-3.7), and vulnerable patients waited a risk-adjusted median of 29 days longer for surgery. Surgical delay was significantly associated with pathologic upstaging (43 % vs 23 %; p < 0.001).

[CONCLUSIONS] High social vulnerability is associated with surgical delay in NSCLC, even after controlling for demographic and clinical factors. Delay is subsequently associated with pathologic upstaging. These findings warrant interventions for vulnerable patients to promote equitable surgical care.