Background: Demographic characteristics, especially race and insurance status, affect the incidence of lung cancer diagnosed at Stage IV¹. This is the largest epidemiological study to determine patient features associated with the development of Stage IV NSCLC. Methods: A population-based study using the National Cancer Database (2000-2012), which contains 70% of all cancer diagnoses in the U.S. from 1658 ACS Accredited-Hospitals. Demographic groups of NSCLC presenting with Stage IV were compared to the entire cohort of NSCLC patients using the Chi square test. Results: Of all NSCLC patients (N=2,956,237), 36% were Stage IV at presentation. Uninsured (52%), aged 40-49 (47%), Medicaid recipients (46%), aged 50-59 (42%), Hispanic (41%) and Black (41%) patients presented with more Stage IV at diagnosis. Medicare recipients (34%) presented with less Stage IV. Adenocarcinoma (AC) and Squamous Cell (SQ) presented with 43% and 25% Stage IV disease at diagnosis, respectively. Uninsured AC (60%) patients had the most frequent Stage IV disease at diagnosis. Conclusions: AC presents much more frequently than SQ as Stage IV. In particular, uninsured AC patients have the most frequent Stage IV presentation. Similar to a previous NCDB study, this study, which includes 5 times as many lung cancer patients as the previous study, shows uninsured, Medicaid, Hispanic and Black NSCLC patients present with more Stage IV disease (Halpern MT, et al. (2008) Association of insurance status and ethnicity with cancer stage at diagnosis for 12 cancer sites: a retrospective analysis. Lancet Oncol 9:222-232.). Conversely, Medicare patients present with less Stage IV disease.