We originally performed this analysis to assess the effects of the presentation and outcome differences by ethnicity as compared to Whites in patients undergoing surgical resection for lung cancer. In comparison to White patients, OS, LCSS, and 90-day mortality were similar or better in all ethnic groups for all three analyses. Median household income was largely not associated with OS or LCSS in the TS and ESR patients, but was strongly associated with 90-day mortality. Because this variable was assigned to patients based upon the median county income, we assume this variable may have adversely affected 90-day survival due to the hospital care received in more wealthy and less affluent areas. Of importance, Medicaid insurance and not being married were associated with lower OS and LCSS as well as an increased risk of 90-day mortality. We feel that not Medicaid insurance is more likely to represent an individual’s economic status and demonstrates the importance of having insurance. However, of great interest, is that having Medicaid and not being married are factors that were also associated with an increased risk of nodal involvement. This suggests that economic and psychological factors can possibly be associated with lung cancer biology. Lower socioeconomic status may affect tumor biology through poor nutrition (29). Recently, it was noted that unmarried lung cancer patients had a greater incidence of depression, less social support, and a survival decrement (30), and that the survival decrement noted in patients with new-onset or persistent depression may be more so in early-stage (Stages I–II) than in patients with more advanced stages (31). We feel that our results suggest that the economic effects of not having insurance and not being married are associated with real changes in tumor biology and aggressiveness.