Boston University School of Medicine, Boston, Massachusetts.
Boston University School of Medicine, Boston, Massachusetts; Department of Surgery, Boston University Medical Center, Boston, Massachusetts.
Ann Thorac Surg. 2022 Apr;113(4):1291-1298. doi: 10.1016/j.athoracsur.2021.04.096. Epub 2021 May 23.
Despite decreases in lung cancer incidence, racial disparities in diagnosis and treatment persist. Residential segregation and structural racism have effects on socioeconomic status for black people, affecting health care access. This study aims to determine the impact of residential segregation on racial disparities in non-small cell lung cancer (NSCLC) treatment and mortality.
Patient data were obtained from Surveillance, Epidemiology, and End Results Program database for black and white patients diagnosed with NSCLC from 2004-2016 in the 100 most populous counties. Regression models were built to assess outcomes of interest: stage at diagnosis and surgical resection of disease. Predicted margins assessed impact of index of dissimilarity (IoD) on these disparities. Competing risk regressions for black and white patients in highest and lowest quartiles of IoD were used to assess cancer-specific mortality.
Our cohort had 193,369 white and 35,649 black patients. Black patients were more likely to be diagnosed at advanced stage than white patients, with increasing IoD. With increasing IoD, black patients were less likely to undergo surgical resection than white patients. Disparities were eliminated at low IoD. Black patients at high IoD had lower cancer-specific survival.
Black patients were more likely to present at advanced disease, were less likely to receive surgery for early stage disease, and had higher cancer-specific mortality at higher IoD. Our findings highlight the impact of structural racism and residential segregation on NSCLC outcomes. Solutions to these disparities must come from policy reforms to reverse residential segregation and deleterious socioeconomic effects of discriminatory policies.
尽管肺癌发病率有所下降，但在诊断和治疗方面仍存在种族差异。居住隔离和结构性种族主义对黑人的社会经济地位产生影响，从而影响医疗保健的可及性。本研究旨在确定居住隔离对非小细胞肺癌（NSCLC）治疗和死亡率的种族差异的影响。
从监测、流行病学和最终结果计划数据库中获取了 2004 年至 2016 年间在人口最多的 100 个县诊断为 NSCLC 的黑人和白人患者的数据。建立回归模型以评估以下感兴趣的结果：诊断时的分期和疾病的手术切除。预测边际评估不相似指数（IoD）对这些差异的影响。在 IoD 最高和最低四分位数的黑人和白人患者中使用竞争风险回归来评估癌症特异性死亡率。
我们的队列包括 193369 名白人患者和 35649 名黑人患者。与白人患者相比，黑人患者更有可能被诊断为晚期疾病，且随着 IoD 的增加，黑人患者更有可能被诊断为晚期疾病。随着 IoD 的增加，黑人患者接受手术切除的可能性低于白人患者。在低 IoD 时，差异被消除。IoD 较高的黑人患者癌症特异性生存率较低。
黑人患者更有可能出现晚期疾病，早期疾病接受手术治疗的可能性较低，IoD 较高的癌症特异性死亡率较高。我们的研究结果强调了结构性种族主义和居住隔离对 NSCLC 结果的影响。这些差异的解决方案必须来自政策改革，以扭转居住隔离和歧视性政策对社会经济的不利影响。
