{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:06:00Z","timestamp":1790143560803,"version":"4.0.1"},"reference-count":56,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T00:00:00Z","timestamp":1752105600000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003478","name":"Ministry of Health, Labour and Welfare","doi-asserted-by":"publisher","award":["23AA2003"],"award-info":[{"award-number":["23AA2003"]}],"id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003478","name":"Ministry of Health, Labour and Welfare","doi-asserted-by":"publisher","award":["22AA2003"],"award-info":[{"award-number":["22AA2003"]}],"id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Recent advances in immunotherapy have improved the survival of patients with non\u2010small cell lung cancer (NSCLC). However, data on the association between patient socioeconomic status (SES) and the use of immunotherapy remain scarce. We examined the association between area\u2010level SES and immunotherapy use in patients with stage IV NSCLC in Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from a national inpatient database were used for this analysis. Patients aged \u2265\u200918\u2009years, hospitalized for stage IV NSCLC, and treated with immunotherapy alone, immunotherapy combined with platinum\u2010based chemotherapy, and platinum\u2010based chemotherapy alone as first\u2010line pharmacotherapy from April 2016 to March 2022 were analyzed. Area\u2010level SES was measured using the area deprivation index and categorized into quartiles. The primary outcome was the use of immunotherapy as a first\u2010line treatment. A multivariate linear regression model was used, adjusted for patient characteristics, years, and hospital fixed effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 47,291 eligible patients from 843 hospitals, with 22,205 (47%) receiving immunotherapy. Adjusted analyses showed that patients in the most disadvantaged area were less likely to receive immunotherapy compared with those in the least disadvantaged area (adjusted difference, \u22122.0 percentage points [pp]; 95% confidence interval, \u22123.6 to \u22120.5\u2009pp;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01). Although not significant, this trend persisted when stratified by urban and cancer\u2010designated hospitals. However, this difference was no longer significant after adjusting for hospital fixed effects.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In Japan, with universal public health insurance with low out\u2010of\u2010pocket costs, living in a socioeconomically disadvantaged area is associated with lower rates of immunotherapy use among patients with stage IV NSCLC. These disparities disappeared within the same hospitals using hospital fixed effects; however, such disparities tended to persist in urban, non\u2010academic, and cancer\u2010designated hospitals. These findings suggest the need for interventions to address the structural barriers, including those within the hospitals, to optimize NSCLC treatment and reduce health disparities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71038","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T10:29:07Z","timestamp":1752143347000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Association Between Area\u2010Level Socioeconomic Disadvantage and Immunotherapy in Patients With Non\u2010Small Cell Lung Cancer"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4288-177X","authenticated-orcid":false,"given":"Hiroe","family":"Suzuki\u2010Chiba","sequence":"first","affiliation":[{"name":"Department of Health Communication Graduate School of Medicine, The University of Tokyo  Tokyo 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