Objective: Patterns of in-hospital surgical care for lung cancer in Western Australia were examined, including the effects of demographic, locational and socioeconomic disadvantage and the possession of private health insurance, on the likelihood of receiving surgery. Patients and methods: The WA Record Linkage Project was used to extract hospital morbidity, cancer and death records of all people with lung cancer in Western Australia from 1982 to 2001. The likelihood of receiving lung cancer surgery was estimated, after adjustment for co- variates, using logistic regression. Results: Overall, 16% of patients received surgery for their lung cancer, although this varied according to histology. Patients who received surgery were typically younger, female, non-Indigenous and had less comorbidity. Patients from socioeconomically disadvantaged groups tended to be less likely to receive surgery (OR 0.79; 95% CI 0.61-1.04) although this was not significant for each category of disadvantage. Those who had their first hospital admission, with a mention of lung cancer, in a rural hospital were less likely to receive surgery (OR 0.26; 95% CI 0.19- 0.36) than those in metropolitan hospitals, although residential location generally had less effect (OR 0.36; 95% CI 0.14-0.92). Patients admitted as a private patient either to a private or public hospital for their first mention of lung cancer had increased likelihood of receiving surgery (OR 1.15; 95% CI 1.02-1.30); however first admission to a private hospital had no effect (OR 0.99: 95% CI 0.85-1.16). Conclusion: The utilisation of lung cancer surgery was low with several factors found to affect the rate. Patients from socioeconomically or locationally disadvantaged backgrounds, Indigenous patients or patients without private health insurance were less likely to receive lung cancer surgery than those from inure advantaged groups.