Liu Qinran, Medina Heidy N, Koru-Sengul Tulay, Rodriguez Estelamari, Lopes Gilberto, Penedo Frank J, Islami Farhad, Pinheiro Paulo S
Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, GA, USA.
Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA.
J Natl Cancer Inst. 2024 Dec 1;116(12):2022-2031. doi: 10.1093/jnci/djae199.
Despite the importance of early detection for lung cancer outcomes, staging disparities among the growing US Hispanic population remain underexplored. This population-based study aimed to identify racial/ethnic disparities among non-Hispanic White, non-Hispanic Black, and Hispanic (including specific subgroups) patients in stage at diagnosis for potentially curable non-small cell lung cancer (NSCLC).
Incident NSCLC cases (2005-2018) were extracted from the Florida cancer registry. Stage was categorized as early (localized/regional) or advanced (distant). Multivariable logistic regression assessed the association between race/ethnicity and stage at diagnosis, adjusting for socioeconomic status, smoking, and clinical factors.
Among 157 034 NSCLC patients, 47.8% were diagnosed at an advanced stage. Multivariable models showed higher odds of advanced-stage diagnosis for non-Hispanic Blacks (adjusted odds ratio [ORadj] = 1.22, 95% confidence interval [CI] = 1.17 to 1.26) and Hispanics (ORadj = 1.03, 95% CI = 1.00 to 1.08) compared with non-Hispanic Whites. Regional differences were stark for Hispanics compared with non-Hispanic Whites: ORadj = 0.96 (95% CI = 0.91 to 1.01) in South Florida vs 1.12 (95% CI = 1.05 to 1.19) in the rest of Florida. In South Florida, Central Americans (ORadj = 1.49, 95% CI = 1.20 to 1.85) were the only Hispanic group showing a staging disadvantage compared with non-Hispanic Whites.
Pronounced disparities in NSCLC staging among non-Hispanic Black and Hispanic populations, with notable regional variations within Florida's Hispanic communities, indicate that targeted interventions could significantly enhance early detection. The relative advantage observed in nearly all minority groups in multicultural South Florida compared with the rest of Florida underscores the need for future research exploring how specific Hispanic and multiracial sociocultural contexts can positively influence the landscape of cancer early detection across the United States.
尽管早期检测对肺癌治疗结果至关重要，但美国不断增长的西班牙裔人群中的分期差异仍未得到充分研究。这项基于人群的研究旨在确定非西班牙裔白人、非西班牙裔黑人以及西班牙裔（包括特定亚组）患者在诊断时对于潜在可治愈的非小细胞肺癌（NSCLC）分期方面的种族/族裔差异。
从佛罗里达州癌症登记处提取2005 - 2018年的新发NSCLC病例。分期分为早期（局限性/区域性）或晚期（远处转移）。多变量逻辑回归评估种族/族裔与诊断时分期之间的关联，并对社会经济地位、吸烟和临床因素进行调整。
在157034例NSCLC患者中，47.8%在晚期被诊断。多变量模型显示，与非西班牙裔白人相比，非西班牙裔黑人（调整后的优势比[ORadj]=1.22，95%置信区间[CI]=1.17至1.26）和西班牙裔（ORadj = 1.03，95% CI = 1.00至1.08）晚期诊断的几率更高。与非西班牙裔白人相比，西班牙裔的地区差异明显：南佛罗里达州的ORadj = 0.96（95% CI = 0.91至1.01），而佛罗里达州其他地区为1.12（95% CI = 1.05至1.19）。在南佛罗里达州，中美洲人（ORadj = 1.49，95% CI = 1.20至1.85）是唯一与非西班牙裔白人相比显示分期劣势的西班牙裔群体。
非西班牙裔黑人和西班牙裔人群在NSCLC分期方面存在明显差异，佛罗里达州西班牙裔社区内存在显著的地区差异，这表明有针对性的干预措施可以显著提高早期检测率。与佛罗里达州其他地区相比，在多元文化的南佛罗里达州几乎所有少数群体中观察到的相对优势凸显了未来研究的必要性，即探索特定的西班牙裔和多种族社会文化背景如何能够积极影响美国癌症早期检测的格局。
