Area-level socioeconomic deprivation and cause-specific survival after lung cancer diagnosis: a population-based cohort study in Naples, Italy
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Lung cancer remains a major public health priority, with survival shaped by clinical, behavioral, socioeconomic, and organizational factors. Socioeconomic disadvantage may affect risk exposure, diagnosis, treatment access, continuity of care, and data completeness. Objective: To assess the association between area-level socioeconomic deprivation and cause-specific survival in lung cancer and apply the M.A.S.T.E.R. (Methodological Approach for Strategic Transformation, Evaluation, and Redesign) framework to translate epidemiological evidence into organizational design and implementation planning. Methods: A retrospective population-based registry cohort study within ASL Napoli 1 Centro included incident malignant tumors of the trachea, lung, and bronchi recorded between 2010 and 2023. Cancer Registry data were integrated with the 2021 Socioeconomic Disadvantage Index (IDISE), Hospital Discharge Records, and progressi delle Aziende Sanitarie per la Salute in Italia (PASSI) 2022-2024 contextual smoking prevalence by sex and Primary Health Care District (DSB). Cause-specific survival was analyzed using multivariable Cox regression with district-clustered robust variance; Fine-Gray competing-risk regression was used as sensitivity analysis. M.A.S.T.E.R. comprised six phases: Mapping and contextualization, analysis and diagnosis, strategic design, testing and adaptive execution, embedding and sustainability, and resilience and renewal. Results: = 0.069); smoking prevalence was not statistically associated with mortality. M.A.S.T.E.R. outputs included a qualitative failure mode and effects analysis (FMEA), a plan, do, study, act (PDSA) protocol with control plan, a completeness dashboard, and plans for updates, audits, and strategic review. Conclusions: Greater area-level socioeconomic deprivation was associated with higher cause-specific mortality in the primary model; the association was attenuated and no longer statistically significant after adding contextual PASSI smoking prevalence. M.A.S.T.E.R. clarified the transition from epidemiological analysis to candidate interventions for prevention, smoking cessation, early diagnosis, patient navigation, and information integration. Outputs from the final four phases are design-oriented and require prospective implementation and validation.
Source: Frontiers in Public Health
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7220743111