BACKGROUND: Lung cancer is the most common cause of cancer related mortality for both Indigenous and non-Indigenous Australians, and the death rate of lung cancer in Indigenous Australians is increasing. AIMS: To provide a comprehensive description of patterns of lung cancer presentation, diagnosis, treatment and outcomes in Indigenous and non-Indigenous Australians in the Top End of the Northern Territory. METHODS: Retrospective cohort study of adult patients with a new diagnosis of lung cancer in the Top End between January 2010 and December 2014. Unadjusted survival probabilities by Indigenous status were calculated. Primary endpoint was all-cause mortality. RESULTS: Despite receiving similar diagnostic procedures and treatment, Indigenous Australians with lung cancer have poorer 1- and 5-year survival (25.0% and 9.4%, respectively), when compared to non-Indigenous Australians included in the study (42.0% and 16.2%, respectively). Indigenous lung cancer patients were more likely to be female (51.6% of Indigenous patients were female, compared to 30.5% non-Indigenous), be current smokers (61.3% vs 36.9%), have more comorbidities (73.6% vs 52.7%, 24.2% vs 5.3% and 30.8% vs 14.2% for respiratory disease, renal insufficiency and diabetes mellitus, respectively), and live in more socioeconomically disadvantaged (66.7% vs 14.2%) and very remote areas (66.1 % vs 6.8%). They were also more likely to die at home, compared to their non-Indigenous counterparts (64.3% vs 26.7%). CONCLUSIONS: Indigenous patients from the Top End diagnosed with lung cancer were more likely to have poorer survival outcomes when compared to non-Indigenous people. Potential reasons for the discrepancy in survival need to be addressed urgently. This article is protected by copyright. All rights reserved.