Lung cancer (NSCLC) is the leading cause of cancer related mortality. Lung cancer screening aims to detect treatable cancers, however survival advantage will only be seen with early and appropriate stage-directed therapy. This study aims to understand recent rates of therapy for early-stage lung cancer in Kentucky, and to explore potential sources of disparities in treatment and outcomes. A Kentucky Cancer Registry query was performed of all NSCLC cases treated in the state from 2005-2014. Of 39,763 lung cancer patients, 10,622 were clinically operable. Of these, overall 40% did not receive surgery, while 16% did not receive any stage-appropriate local therapy. Wide variation was noted in rates of surgery and local therapy at the county level. Increased age, non-private insurance status, non-white race, male gender, and non-married status were less likely to receive surgery. Median survival in patients who underwent surgery was 59.1 months vs 16 months (p< 0.001). Appropriate stage-directed local therapy is a very important factor in survival of patients with early stage NSCLC. County-level variation in rates of therapy need further study. Demographic factors continue to drive disparities in therapy and outcomes in Kentucky and should inform health policy and ongoing research and education efforts.