The role of comorbidities in the incidence and mortality of lung cancer: a large, nationwide retrospective study based on Hungarian datasets

Introduction: The mortality and overall survival of lung cancer depend on various factors. In our study, we examined the prevalence and effect on mortality of comorbidities. Method Data records from Hungarian patients diagnosed with lung cancer between 2012 and 2020 were enrolled. We examined the occurrence of comorbidities and the Charlson comorbidity index prior to lung cancer diagnosis with a matched-pairs methodology. Multivariate logistic regression assessed short- and long-term mortality, while Kaplan-Meier curves and Cox regression analyzed survival probabilities. Results 42,207 patients were enrolled. The differences in the occurrences of diabetes, arrhythmia, and renal failure were not significant between case and control groups. Anemia was moderate, cardiological conditions were significantly more frequent in the case group. Charlson index showed a less favorable risk profile in the case group. Surgical patients had significantly lower crude mortality rate. The odds of mortality are significantly increased at the 0.1% level with another primary tumor appearance, anemia, cerebrovascular disease, heart failure, arrhythmia, COPD, or pneumonia. The odds of mortality are significantly lower for patients diagnosed with hypertension or asthma (p < 0.001). Operated patients have a lower Charlson comorbidity index and better hazard ratios. Higher Charlson comorbidity category is associated with higher hazard ratio for survival. Conclusion Our study demonstrates that while high Charlson Comorbidity Index scores, COPD, heart failure, cerebrovascular disease, arrhythmia, pneumonia, and anemia increase lung cancer mortality, surgery – and surprisingly, hypertension and asthma – are linked to significantly better survival. This phenomenon should be noted for screening, diagnostic methods, and treatment choice.