Introduction: Inequality in lung cancer is a major problem and is affecting time to diagnosis, stage at diagnosis and mortality. To aim specific interventions that could reduce mortality of lung cancer, further characterization is required of people with the greatest risk of developing lung cancer.

Aims and objectives: Compare lung cancer patients at the time of diagnosis and matched controls on employment status, adjusted for education status.

Methods: Using the nationwide Cancer Registry and Statistics Employment Registry, all lung cancer patients in Denmark, aged 18-64 years in the period 1994-2018, were identified. The patients were divided into a period I cohort (1994-2007) and a period II cohort (2008-2018) and matched with controls at a 1:4 ratio by age, gender, marital status, and municipality at time of diagnosis. A multinomial logistic regression was performed to assess odds ratio of lung cancer for employment status.

Results: Compared with matched controls in both time periods lung cancer patients are more often: Unemployed at time of diagnosis; odds ratio 1.66 (95% CI 1.56-1.76) 1994-2007 vs. 1.81 (95% CI 1.69-1.94) 2008-2018. On disability pension; odds ratio 2.37 (95% CI 2.28-2.47) 1994-2007 vs. 2.24 (95% CI 2.13-2.34) 2008-2018. On early retirement; odds ratio 1.36 (95% CI 1.29-1.42) 1994-2007 vs. 1.31 (95% CI 1.23-1.39) 2008-2018.

Conclusions: Lung cancer patients were more likely to be unemployed, on disability pension or on early retirement. This information is of great importance when aiming specific interventions to prevent lung cancer and promote early detection. If a lung cancer screening program is planned these groups should receive particular attention in the recruitment strategy.