Department of Public Health Sciences, Clemson University, Clemson, SC, United States.
Louisiana Tumor Registry, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States.
Front Public Health. 2021 Jun 2;9:662876. doi: 10.3389/fpubh.2021.662876. eCollection 2021.
Delayed surgery is associated with worse lung cancer outcomes. Social determinants can influence health disparities. This study aimed to examine the potential racial disparity and the effects from social determinants on receipt of timely surgery among lung cancer patients in Louisiana, a southern state in the U.S. White and black stage I-IIIA non-small cell lung cancer patients diagnosed in Louisiana between 2004 and 2016, receiving surgical lobectomy or a more extensive surgery, were selected. Diagnosis-to-surgery interval >6 weeks were considered as delayed surgery. Social determinants included marital status, insurance, census tract level poverty, and census tract level urbanicity. Multivariable logistic regression and generalized multiple mediation analysis were conducted. A total of 3,616 white (78.9%) and black (21.1%) patients were identified. The median time interval from diagnosis to surgery was 27 days in whites and 42 days in blacks ( < 0.0001). About 28.7% of white and 48.4% of black patients received delayed surgery ( < 0.0001). Black patients had almost two-fold odds of receiving delayed surgery than white patients (adjusted odds ratio: 1.91; 95% confidence interval: 1.59-2.30). Social determinants explained about 26% of the racial disparity in receiving delayed surgery. Having social support, private insurance, and living in census tracts with lower poverty level were associated with improved access to timely surgery. The census tract level poverty level a stronger effect on delayed surgery in black patients than in white patients. Tailored interventions to improve the timely treatment in NSCLC patients, especially black patients, are needed in the future.
延迟手术与肺癌预后不良有关。社会决定因素会影响健康差距。本研究旨在检查美国南部路易斯安那州肺癌患者及时接受手术的潜在种族差异以及社会决定因素的影响。选择了在路易斯安那州 2004 年至 2016 年间诊断为 I 期至 IIIA 期非小细胞肺癌、接受肺叶切除术或更广泛手术的白人及黑人患者。将诊断至手术的时间间隔>6 周视为延迟手术。社会决定因素包括婚姻状况、保险、普查区贫困程度和普查区城市化程度。采用多变量逻辑回归和广义多重中介分析。共确定了 3616 名白人（78.9%）和黑人（21.1%）患者。白人的手术时间中位数为 27 天，黑人的手术时间中位数为 42 天（<0.0001）。约 28.7%的白人患者和 48.4%的黑人患者接受了延迟手术（<0.0001）。黑人患者接受延迟手术的几率几乎是白人患者的两倍（调整后的优势比：1.91；95%置信区间：1.59-2.30）。社会决定因素解释了接受延迟手术的种族差异的约 26%。有社会支持、私人保险和生活在贫困程度较低的普查区与及时获得手术机会有关。普查区贫困程度对黑人患者延迟手术的影响强于白人患者。未来需要针对非小细胞肺癌患者，尤其是黑人患者，制定有针对性的干预措施，以改善他们的及时治疗。
