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Original Research |

Racial and Ethnic Disparities in Early-Stage Lung Cancer Survival

Samir Soneji, PhD; Nichole T. Tanner, MD, MSCR; Gerard A. Silvestri, MD, MS; Christopher Lathan, MD; William Black, MD
Author and Funding Information

Conflict of Interest Statement: No conflicts of interest exist for any of the authors.

Funding Information: This work was supported by the National Institutes of Health (R21-CA197912 to S.S.) and the American Lung Association (to S.S.).

Prior Abstract Publication/Presentation: None.

aDartmouth Institute for Health Policy & Clinical Practice

bDepartment of Radiology

cDepartment of Community and Family Medicine

dGeisel School of Medicine at Dartmouth and the Norris Cotton Cancer Center, Lebanon, New Hampshire

eDivision of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts

fMedical University of South Carolina Thoracic Oncology Research Group and Division of Pulmonary Critical Care Medicine

gRalph H. Johnson Veterans Affairs Hospital and Health Equity and Rural Outreach Innovation Center

Corresponding Author Information: Samir Soneji, PhD, The Dartmouth Institute for Health Policy, One Medical Center Drive, Lebanon, NH 03756.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.03.059
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Abstract

Background  Black lung cancer patients diagnosed at early stages—for which surgical resection offers a potential cure—experience worse overall survival than their White counterparts. We undertook a population-based study to estimate the racial and ethnic disparity in death from competing causes and assessed its contribution to the gap in overall survival among early-stage lung cancer patients.

Methods  We collected survival time data for 105,121 early-stage (IA, IB, IIA, and IIB) Hispanic, non-Hispanic Asian, non-Hispanic Black, and non-Hispanic White lung cancer patients diagnosed between 2004 and 2013 from the Surveillance, Epidemiology, and End-Results registries. We modeled survival time using competing risk regression and included as covariates sex, age at diagnosis, race/ethnicity, stage at diagnosis, histology, type of surgical resection, and radiation sequence.

Results  Adjusting for demographic, clinical, and treatment characteristics, non-Hispanic Blacks experienced worse overall survival compared to non-Hispanic Whites (adjusted hazard ratio [aHR]: 1.05; 95% confidence interval [CI]: 1.02,1.08) while Hispanics and non-Hispanic Asians experienced better overall survival (aHR=0.93; 95% CI: 0.89, 0.98 and aHR=0.82; 95% CI: 0.79, 0.86, respectively). Worse survival from competing causes of death, such as CVD and other cancers—rather than from lung cancer itself—led to the disparity in overall survival among non-Hispanic Blacks (adjusted relative risk=1.07; 95% CI: 1.02, 1.12).

Conclusions  Narrowing racial and ethnic disparities in survival among early-stage lung cancer patients will rely on more than just equalizing access to surgical resection and will need to include better management and treatment of smoking-related comorbidities and diseases.


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