The direct and indirect impact of comorbidity on the survival of patients with non-small cell lung cancer: a combination of survival, staging and resection models with missing measurements in covariates

BMJ Open. 2014 Feb 12;4(2):e003846. doi: 10.1136/bmjopen-2013-003846.

Abstract

Objective: To examine the direct and indirect impact of comorbidity on the survival.

Design: A historical cohort study.

Setting: Denmark.

Participants: All patients with non-small cell lung cancer who were registered in the Danish Lung Cancer Registry in 2010.

Main outcome measures: The influence of comorbidity on stage misclassification, probability of resection and survival.

Results: It was estimated that the comorbidity influences the probability of resection with OR 0.65 and 95% credible interval (0.54; 0.79), the staging process with OR 1.08 and 95% credible interval (0.96; 1.20), and the survival process with HR 1.08 and 95% credible interval (1.02; 1.14).

Conclusions: We found that comorbidity has a significant indirect effect on survival mediated by the resection process and a slightly direct effect on mortality.

Keywords: STATISTICS & RESEARCH METHODS.

MeSH terms

  • Aged
  • Carcinoma, Non-Small-Cell Lung / mortality*
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Carcinoma, Non-Small-Cell Lung / surgery*
  • Comorbidity*
  • Denmark
  • Female
  • Humans
  • Lung Neoplasms / mortality*
  • Lung Neoplasms / pathology
  • Lung Neoplasms / surgery*
  • Male
  • Models, Statistical
  • Neoplasm Staging
  • Prognosis
  • Registries
  • Risk Factors
  • Survival Analysis*