Association between COPD and Stage of Lung Cancer Diagnosis - A Population-Based Study

Sep 24, 2026

Chronic obstructive pulmonary disease (COPD) increases lung cancer risk, yet the link between COPD and the stage at lung cancer diagnosis is unclear. A population-based cross-sectional analysis was conducted on Ontario lung cancer patients from 2008–2020, using estimated propensity scores, inverse probability weighting, and logistic regression to model stage at diagnosis while accounting for prior chest imaging. COPD coexisted in over half of patients (55%). Compared with no COPD, COPD was associated with 30% lower odds of advanced-stage diagnosis (OR 0.70, 95% CI 0.68–0.72).

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

Introduction

Study objective and rationale

Methods

Study design and data sources

Statistical approach

Results

COPD prevalence among lung cancer patients

Association between COPD and diagnosis stage

Discussion

Clinical implications for diagnostics

Article Association between COPD and Stage of Lung Cancer Diagnosis: A Population-Based Study Stacey J. Butler 1,2,3, Alexander V. Louie 3, Rinku Sutradhar 2,3,4, Lawrence Paszat 2,3,5, Dina Brooks 6 and Andrea S. Gershon 1,2,3,5, * Citation: Butler, S.J.; Louie, A.V.; Sutradhar, R.; Paszat, L.; Brooks, D.; Gershon, A.S. Association between COPD and Stage of Lung Cancer Diagnosis: A Population-Based Study. Curr. Oncol. 2023, 30, 6397–6410 . [https://doi.org/10.3390/](https://doi.org/10.3390/)[ ](https://doi.org/10.3390/)curroncol30070471 Received: 2 June 2023 Revised: 26 June 2023 Accepted: 1 July 2023 Published: 5 July 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) . 1 Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada; stacey.butler@utoronto.ca 2 ICES, Toronto, ON M4N 3M5, Canada; [rinku.sutradhar@ices.on.ca](rinku.sutradhar@ices.on.ca) (R.S.); [lawrence.paszat@sunnybrook.ca](lawrence.paszat@sunnybrook.ca) (L.P.) 3 Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; [alexander.louie@sunnybrook.ca](alexander.louie@sunnybrook.ca) 4 Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada 5 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada 6 School of Rehabilitation Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada; [brookd8@mcmaster.ca](brookd8@mcmaster.ca) * Correspondence: [andrea.gershon@ices.on.ca](andrea.gershon@ices.on.ca) Abstract: Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of lung cancer; however, the association between COPD and stage of lung cancer diagnosis is unclear. We conducted a population-based cross-sectional analysis of lung cancer patients (2008–2020) in Ontario, Canada. Using estimated propensity scores and inverse probability weighting, logistic regression models were developed to assess the association between COPD and lung cancer stage at diagnosis (early: I/II, advanced: III/IV), accounting for prior chest imaging. We further examined associations in subgroups with previously diagnosed and undiagnosed COPD. Over half (55%) of all lung cancer patients in Ontario had coexisting COPD (previously diagnosed: 45%, undiagnosed at time of cancer diagnosis: 10%) . Compared to people without COPD, people with COPD had 30% lower odds of being diagnosed with lung cancer in the advanced stages (OR = 0.70, 95% CI: 0.68 to 0.72) . Prior chest imaging only slightly attenuated this association (OR = 0.77, 95% CI: 0.75 to 0.80) . The association with lower odds of advanced-stage diagnosis remained, regardless of whether COPD was previously diagnosed (OR = 0.68, 95% CI: 0.66 to 0.70) or undiagnosed (OR = 0.77, 95% CI: 0.73 to 0.82) . Although most lung cancers are detected in the advanced stages, underlying COPD was associated with early-stage detection. Lung cancer diagnostics may beneﬁt from enhanced partnership with COPD healthcare providers. Keywords: lung cancer; diagnostics; chronic obstructive pulmonary disease 1. Introduction Given the shared risk factors and underlying disease mechanisms, chronic obstructive pulmonary disease (COPD) is a common comorbidity among lung cancer patients [1] . People with COPD have a higher risk of developing lung cancer compared to people without COPD, regardless of their smoking history [2–4] . People with COPD also have worse lung cancer outcomes when compared to people without COPD [5,6] and utilize more healthcare resources [6,7] . Diagnosis of lung cancer in the early stages is imperative to initiate cancer treatment and give

FAQs

What question does the study address about COPD and lung cancer?

It examines whether COPD is associated with the stage at which lung cancer is diagnosed.

How was the relationship between COPD and lung cancer stage analyzed?

Researchers used propensity score estimation with inverse probability weighting and logistic regression, accounting for prior chest imaging.

What did the study find regarding advanced-stage diagnosis?

Compared with people without COPD, those with COPD had lower odds of being diagnosed with advanced-stage lung cancer (OR 0.70, 95% CI 0.68–0.72).

Sep 24, 2026

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