Blacks more likely to present at advanced stage, less likely to receive surgery, have higher mortality at higher residential segregation levels.
Black patients are more likely to present with advanced non-small cell lung cancer (NSCLC) and are less likely to receive surgery at higher residential segregation levels, according to a study presented at the annual meeting of the Society of Thoracic Surgeons, held virtually from Jan. 29 to 31.
Chandler Annesi, from the Boston University School of Medicine, and colleagues examined racial disparities of NSCLC treatment and mortality outcomes in association with residential segregation. The exposure of interest was the index of dissimilarity (IoD), which is a validated proxy for structural racism. Data were included for 35,649 Black and 193,369 White patients with NSCLC from 2004 to 2016.
The researchers found that Black patients had an increased risk for presenting at an advanced stage (RR, 1.49), while for White patients, the risk for presenting at an advanced stage increased with increasing IoD (RR, 1.43). The likelihood of undergoing surgical resection was lower for Black patients (RR, 0.37); among Whites, the likelihood of undergoing surgical resection was reduced with increasing IoD (RR, 0.56). At low levels of segregation, disparities between Black and White patients were eliminated for both stage at diagnosis and the likelihood of surgical resection. For Black patients, median cancer-specific survival differed significantly at high and low IoD (10 versus 12 months). Median cancer-specific survival was 10 and 13 months for Black and White patients, respectively, at high IoD.
“As we show in our research, segregation, the resulting devaluation of black communities, and other downstream factors have led to wide disparities in lung cancer outcomes,” Annesi said in a statement.