1 Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Charleston, South Carolina; and.
2 Division of Pulmonary and Critical Care Medicine.
Am J Respir Crit Care Med. 2015 Jul 15;192(2):200-8. doi: 10.1164/rccm.201502-0259OC.
Black individuals with lung cancer (LC) experience higher mortality because they present with more advanced disease and are less likely to undergo curative resection for early-stage disease. The National Lung Screening Trial (NLST) demonstrated improved LC mortality by screening high-risk patients with low-dose computed tomography (LDCT). The benefit of LDCT screening in black individuals is unknown.
Examine results of the NLST by race.
This was a secondary analysis of a randomized trial (NCT00047385) performed in 33 U.S. centers.
Overall and lung cancer-specific mortality were measured. Screening with LDCT reduced LC mortality in all racial groups but more so in black individuals (hazard ratio [HR], 0.61 vs. 0.86). Smoking increased the likelihood of death from LC, and when stratified by race black smokers were twice as likely to die as white smokers (HR, 4.10 vs. 2.25). Adjusting for sociodemographic and behavioral characteristics, black individuals experienced higher all-cause mortality than white individuals (HR, 1.35; 95% confidence interval, 1.22-1.49); however, black individuals screened with LDCT had a reduction in all-cause mortality. Black individuals were younger, were more likely to be current smokers, had more comorbidities, and had fewer years of formal education than white individuals (P < 0.05).
Black individuals screened with LDCT had decreased mortality from lung cancer. However, the demographics associated with improved LC survival were less commonly found in black individuals. The overall mortality in the NLST was higher for black individuals than white individuals, but improved in black individuals screened, suggesting that this subgroup may have had improved access to care. To realize the reductions in mortality from LC screening, dissemination efforts need to be tailored to meet the needs of this community.
肺癌（LC）患者的死亡率较高，这是因为他们的病情更为晚期，且早期疾病接受根治性切除术的可能性较低。国家肺癌筛查试验（NLST）通过对高危患者进行低剂量计算机断层扫描（LDCT）筛查，证实了 LC 死亡率的降低。但 LDCT 筛查在黑人中的获益尚不清楚。
按种族分析 NLST 的结果。
这是在美国 33 个中心进行的一项随机试验（NCT00047385）的二次分析。
总体和肺癌特异性死亡率。LDCT 筛查降低了所有种族组的 LC 死亡率，但对黑人的降低更为显著（风险比 [HR]，0.61 对 0.86）。吸烟增加了肺癌死亡的可能性，且按种族分层时，黑人吸烟者死于肺癌的可能性是白人吸烟者的两倍（HR，4.10 对 2.25）。调整社会人口统计学和行为特征后，黑人的全因死亡率高于白人（HR，1.35；95%置信区间，1.22-1.49）；然而，接受 LDCT 筛查的黑人全因死亡率降低。黑人比白人更年轻、更可能是当前吸烟者、合并症更多、受正规教育年限更少（P < 0.05）。
接受 LDCT 筛查的黑人肺癌死亡率降低。然而，与改善 LC 生存相关的人口统计学特征在黑人中较少见。NLST 中黑人的总体死亡率高于白人，但接受筛查的黑人死亡率有所改善，这表明这一亚组可能获得了更好的医疗服务。为了实现 LC 筛查死亡率的降低，传播工作需要根据该社区的需求进行调整。
