BACKGROUND AND OBJECTIVE In New Zealand, lung cancer is the commonest cause of cancer death in men and is projected to become the commonest cause in women by 2011. Rates of survival from lung cancer are among the lowest in the developed world. There are discrepancies between health outcomes according to patients' ethnicity and socioeconomic status in many diseases. This study determined the incidence of lung cancer, duration of survival and treatment according to ethnicity and socioeconomic status in a health district in New Zealand. METHODS A retrospective review was conducted of patients diagnosed with lung cancer in the period 1997-1999. Data were collected on ethnicity, gender, socioeconomic status and cancer stage at diagnosis. Treatment and 5-year survival were recorded. RESULTS A total of 102 eligible patients were identified. Māori had 3-4 times the incidence of lung cancer compared with New Zealand Europeans and patients from the more socially deprived areas had nearly double the incidence. More than one half of the patients presented with widespread disease, with a disproportionate number of these being from Māori and socially deprived groups. Only 9.8% of cases were considered to be potentially curative. Survival at 1 year was 24% and at 5 years, 6%. No Māori were alive at 5 years. CONCLUSIONS Lung cancer disproportionately affects Māori and socially disadvantaged persons in New Zealand society. Survival at 5 years is low, especially in these groups.