Black patients more likely to be diagnosed with late stage lung cancer, regardless of income, education level

Story at a glance

• Lung cancer remains one of the leading causes of cancer-related death in America, and disproportionately impacts vulnerable communities.

• Looking at data collected between 2004 and 2016, researchers assessed late-stage diagnosis rates among different racial/ethnic populations.

• After adjusting for insurance type, treatment facility type, and other factors, Black individuals were more likely than their white counterparts to be diagnosed with the disease.

Black Americans living in areas with the highest income and education levels were still more likely than white patients in the lowest education and income areas to have advanced-stage lung cancer, underscoring the impact of structural racism on health outcomes, according to a new study published Monday.

“Strikingly, for Black [patients], higher income did not necessarily translate to better outcomes compared with white [patients],” said co-author Tomi F. Akinyemiju of Duke University School of Medicine in a statement.

“This highlights the urgent need for targeted efforts to ensure equitable access to smoking cessation and lung cancer screening, and additional research into other factors that drive lung cancer aggressiveness in Black [populations].”

Adjusting for income and education, researchers assessed demographic data from the 2004-2016 National Cancer Database of all patients diagnosed with any stage of non-small cell lung cancer during that time frame.

Lung cancer accounts for almost a quarter of all U.S. cancer deaths each year and, independent of skin cancer, is the second most common form of the disease behind prostate cancer in men and breast cancer in women, according to the American Cancer Society.

For advanced stages of lung cancer, some estimates put a 5-year survival rate at less than 10 percent.

Although research indicates rates of lung cancer mortality have fallen in recent years due in part to smoking cessation campaigns and early detection strategies, racial and socioeconomic disparities in those diagnosed with advanced lung cancer persist.

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More than 1.3 million patients were included in the final sample and of those, 50 percent of non-Hispanic Black patients resided in the lowest income quartile compared with 17 percent of non-Hispanic white patients.

Similarly, around one-fifth of white patients lived in a region with a higher proportion of adults lacking a high school education, while over 40 percent of Black patients lived in these areas.

Data showed Black Americans living in an area with a lower education level were 12 percent more likely to receive an advance-stage diagnosis than those in high education areas. Those in the lowest income quartile were 13 percent more likely to receive this diagnosis compared with high-income patients.

Factors such as redlining, housing discrimination, and exclusionary zoning implemented throughout American history contribute to the negative health outcomes seen in these environments, said Erica T. Warner in an accompanying editorial.

“These factors, combined with the lack of a comprehensive social safety net to support marginalized populations living in under-resourced neighborhoods, underlie the findings of this study,” Warner wrote.

Study findings were also consistent after adjusting for cancer treatment facility and insurance type, but were not observed among uninsured patients. Researchers were unable to determine patients’ smoking status and history due to a lack of available data.

Because racial differences in cancer outcomes persist independent of socioeconomic factors, authors stress the importance of additional strategies to mitigate these disparities beyond equalizing socioeconomic status.

“Implementing policies to eliminate structural racism in the United States will be necessary to reduce racial gaps in [socioeconomic status] and address other fundamental causes of racial differences in cancer outcomes among low-[socioeconomic status] and racial minority groups,” they wrote.

Disparities in lung cancer screening rates could also play a role in the gaps observed, as earlier detection can help prevent worse long-term outcomes.

“A clear and concerted effort is needed to increase the early detection of [non-small cell lung cancer]. We know where the highest need is, and we must meet people where they are,”said Warner. “As implementation of lung cancer screening advances, it must be done with equity in mind.”

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