Purpose Non–small cell lung cancer (NSCLC) is among the leading causes of cancer death in the United States. Previous studies found mixed results regarding disparities in survival by race, ethnicity, and socioeconomic status (SES). However, race comparisons were usually limited, with comparisons made between black and white patients only or by merging race and ethnicity together as non-Hispanic black, non-Hispanic white, and Hispanic patients. Even fewer studies included race, ethnicity, and SES together while controlling for extensive confounding variables. Thus, because we have access to a large and unique population-based database that includes tumor characteristics and patient comorbidities, the purpose of this study was to explore disparities in NSCLC survival. Methods We linked data from the 1996 to 2007 Florida Cancer Data System registry to the Florida’s Agency for Health Care Administration and the US Census (n = 98,541). Survival time was from date of diagnosis to death or last contact. Race was white, black, Native American, Asian, Pacific Islander, Asian Indian/Pakistani, or other. Ethnicity was non-Hispanic or Hispanic. Socioeconomic status was measured as percentage of the participant’s census tract living below the federal poverty line. Median survival and survival rates were calculated by Kaplan-Meier method. Cox proportional hazards regression models produced unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs). Results The majority of patients were white (91.9%) and non-Hispanic (94.1%). Blacks had the lowest median survival (8.4 months). At 5 years after diagnosis, survival rate was highest in whites (16.3%) and lowest for Pacific Islanders (6.4%). In the adjusted model, Asians had significantly improved survival compared with whites (HR, 0.85; 95% CI, 0.76–0.95). Patients in middle-low (HR, 0.96; 95% CI, 0.94–0.99), middle-high (HR, 0.92; 95% CI, 0.89–0.94), and highest (HR, 0.87; 95% CI, 0.84–0.91) SES areas had significantly improved survival compared with those in lowest areas. Significantly worse survival was found for patients with complicated diabetes (HR, 1.05; 95% CI, 1.01–1.08), weight loss (HR, 1.08; 95% CI, 1.06–1.11), fluid and electrolyte disorders (HR, 1.08; 95% CI, 1.06–1.11), and alcohol abuse (HR, 1.11; 95% CI, 1.07–1.14). Discussion We found strong evidence for racial and socioeconomic disparities in Floridian NSCLC survival. Asians had improved survival compared with whites, a novel finding. Our findings confirmed that patients living in lower socioeconomic neighborhoods have worse outcomes than their wealthier neighborhood counterparts. Finally, we found an association between some modifiable factors/comorbidities and worse survival. Clinicians may be able to use this information to improve patients’ likelihood of better outcomes.

Timely hemorrhage control is paramount in trauma; however, a critical time interval from emergency department arrival to operation for hypotensive gunshot wound (GSW) victims is not established. We hypothesize that delaying surgery for more than 10 minutes from arrival increases all-cause mortality in hypotensive patients with GSW. Data of adults (n = 309) with hypotension and GSW to the torso requiring immediate operation from January 2004 to September 2013 were retrospectively reviewed. Patients with resuscitative thoracotomies, traumatic brain injury, transfer from outside institutions, and operations occurring more than 1 hour after arrival were excluded. Survival analysis using multivariate Cox regression models was used for comparison. Hazard ratios (HRs) and 95% confidence intervals (CIs) are reported. Statistical significance was considered at p ≤ 0.05. The study population was aged 32 ± 12 years, 92% were male, Injury Severity Score was 24 ± 15, systolic blood pressure was 81 ± 29 mm Hg, Glasgow Coma Scale score was 13 ± 4. Overall mortality was 27%. Mean time to operation was 19 ± 13 minutes. After controlling for organ injury, patients who arrived to the operating room after 10 minutes had a higher likelihood of mortality compared with those who arrived in 10 minutes or less (HR, 1.89; 95% CI, 1.10-3.26; p = 0.02); this was also true in the severely hypotensive patients with systolic blood pressure of 70 mm Hg or less (HR, 2.67; 95% CI, 0.97-7.34; p = 0.05). The time associated with a 50% cumulative mortality was 16 minutes. Delay to the operating room of more than 10 minutes increases the risk of mortality by almost threefold in hypotensive patients with GSW. Protocols should be designed to shorten time in the emergency department. Further prospective observational studies are required to validate these findings. Therapeutic study, level IV.

Objective: Research into risk and protective factors for psychiatric disorders may help reduce the burden of these conditions. Spirituality and religion are 2 such factors, but research remains limited. Using a representative national sample of respondents, this study examines the relation between worship frequency and the importance of spiritual values and DSM-IV psychiatric and substance use disorders. Method: In 2002, the Canadian Community Health Survey obtained data from about 37 000 individuals aged 15 years or older. While controlling for demographic characteristics, we determined odds ratios for lifetime, 1-year, and past psychiatric disorders, with worship frequency and spiritual values as predictors. Results: Higher worship frequency was associated with lower odds of psychiatric disorders. In contrast, those who considered higher spiritual values important (in a search for meaning, in giving strength, and in understanding life's difficulties) had higher odds of most psychiatric disorders. Conclusion: This study confirms an association between higher worship frequency and lower odds of depression and it expands that finding to other psychiatric disorders. The association between spiritual values and mood, anxiety, and addictive disorders is complex and may reflect the use of spirituality to reframe life difficulties, including mental disorders.