A number of factors, including improved medical care, have led to an ever-increasing age among the general patient population. However, advanced age is not typically considered a contraindication for lung surgery, and the number of patients over the age of 65 years presenting for surgery has been steadily increasing. Our data are in concordance with this described phenomenon. Although the overall change in the average age has been relatively small (2.1 years), the impact of this change becomes obvious when viewing these data in conjunction with trends in the patients’ sources of payment. As the average age is approaching 65 years, the number of procedures paid for by Medicare also increased. Interestingly, the proportion of private payers increased as well, while the percentage of patients being paid for by other sources decreased. These results warrant further investigation in order to assess the financial impact on various aspects of the health-care system.
The proportion of women undergoing lung surgery increased substantially over the study period from 40.1% in the period from 1988 to 1992 to 49.6% in the period from 1998 to 2002. This change may be due to the marked decrease of the male/ female incidence ratio of lung cancer and to the fact that women with local disease have been found to undergo surgery as an initial treatment more frequently than men. Race has also been implicated as a factor in undergoing surgical resection for the treatment of early-stage lung cancer. For instance, Bach et al reported a lower rate of surgical treatment among blacks compared to whites. Our data show decreases in the percentages of both whites and blacks undergoing procedures, while the percentage of patients with no race reported increased. Due to increases in the number of patients with race not reported, we cannot draw conclusions regarding this study category. However, an analysis of the NHDS participating hospitals found that facilities with high rates of missing data for race served populations with higher than average white/black patient ratios. Improved reporting and accuracy of race/ethnicity data will be vital to understanding and eliminating the potential disparities in the patients undergoing surgery for racial/ethnic groups.