Características clinicoasistenciales y factores asociados a la mortalidad intrahospitalaria por cáncer de pulmón en España / Clinical care characteristics and factors associated with in-hospital mortality for lung cancer in Spain

Background and objective: Lung cancer causes high morbimortality in Spain and is currently experiencing a significant increase in women. The aim of this study was to describe differential clinical and health care characteristics by sex, as well as factors associated with and geographic differences of in-hospital mortality. Material and method: Descriptive study of episodes registered in the National Hospital Discharge Minimum Basic Data Set for admission type and gender in 2005. Two logistic regression models by sex were built in order to explain the individual influence of variables on in-hospital mortality. Using predictive values of the models, standardized mortality rates were calculated to study the variation between Spanish regions. Results: Women presented a lower mean age, smoking habit and in-hospital mortality than men. However, women presented more adenocarcinomas, greater care in high volume centers, more surgery in readmissions and were subjected to chemotherapy more often in new admissions than men. Adenocarcinoma in men and no specific location in women were associated with higher mortality. Smoking habit and lung diagnosis procedures in men, and middle lobe location and bronchoscopy in women were associated with lower mortality. The geographical mortality pattern detected was similar in both sexes only in some regions of Spain. Conclusions: Differential clinical characteristics, health care and overall results appear to exist depending on individuals’ gender. Recognition of these differences are crucial in order to improve the effectiveness and equity of our health care system (AU)

Fundamento y objetivo: El cáncer de pulmón produce elevada morbimortalidad en España, con un notable incremento actual en las mujeres. El objetivo de este estudio es describir, en función del sexo, las características clínicas y asistenciales, así como los factores asociados y las diferencias geográficas de la mortalidad intrahospitalaria en pacientes con cáncer de pulmón. Material y método: Se estudiaron descriptivamente los episodios del conjunto mínimo básico de datos al alta hospitalaria nacional de 2005 por tipo de ingreso y sexo. Se construyeron dos modelos de regresión logística según sexo para explicar la influencia individual de las variables de interés en la mortalidad intrahospitalaria. Mediante las predicciones resultantes se obtuvieron razones de mortalidad estandarizadas para estudiar las comunidades autónomas. Resultados: Las mujeres presentan menor edad media, tabaquismo y mortalidad intrahospitalaria, y en mayor grado adenocarcinomas, atención en centros de alto volumen, cirugía en reingresos y quimioterapia en nuevos ingresos que los varones. El adenocarcinoma en varones y la localización no especificada en mujeres se asocian a mayor mortalidad. El tabaquismo y las pruebas diagnósticas pulmonares en varones, y la localización en lóbulo medio y la broncoscopia en mujeres están asociados a una menor mortalidad. El patrón geográfico de mortalidad detectado es similar en ambos sexos en algunas comunidades, pero difiere en otras. Conclusiones: Existen características diferenciales clínicas, asistenciales y de resultados en función del sexo del paciente. Su reconocimiento es crucial para conseguir mejorar la efectividad y equidad de nuestro sistema sanitario (AU)

[Clinical care characteristics and factors associated with in-hospital mortality for lung cancer in Spain]. / Características clinicoasistenciales y factores asociados a la mortalidad intrahospitalaria por cáncer de pulmón en España.

BACKGROUND AND OBJECTIVE: Lung cancer causes high morbimortality in Spain and is currently experiencing a significant increase in women. The aim of this study was to describe differential clinical and health care characteristics by sex, as well as factors associated with and geographic differences of in-hospital mortality. MATERIAL AND METHOD: Descriptive study of episodes registered in the National Hospital Discharge Minimum Basic Data Set for admission type and gender in 2005. Two logistic regression models by sex were built in order to explain the individual influence of variables on in-hospital mortality. Using predictive values of the models, standardized mortality rates were calculated to study the variation between Spanish regions. RESULTS: Women presented a lower mean age, smoking habit and in-hospital mortality than men. However, women presented more adenocarcinomas, greater care in high volume centers, more surgery in readmissions and were subjected to chemotherapy more often in new admissions than men. Adenocarcinoma in men and no specific location in women were associated with higher mortality. Smoking habit and lung diagnosis procedures in men, and middle lobe location and bronchoscopy in women were associated with lower mortality. The geographical mortality pattern detected was similar in both sexes only in some regions of Spain. CONCLUSIONS: Differential clinical characteristics, health care and overall results appear to exist depending on individuals' gender. Recognition of these differences are crucial in order to improve the effectiveness and equity of our health care system.