Mamudu Lohuwa, Sulley Saanie, Atandoh Paul H, Reyes Joanne L, Bashar Raquibul A K M, Whiteside Martin, McEligot Archana J, Mamudu Hadii M, Williams Faustine
Department of Public Health, California State University, Fullerton, Fullerton, CA, United States of America.
National Healthy Start Association, Washington, DC, United States of America.
PLoS One. 2025 Jan 3;20(1):e0311186. doi: 10.1371/journal.pone.0311186. eCollection 2025.
Early initiation of treatment for lung cancer has been shown to improve patient survival. The present study investigates disparities in time to treatment initiation of invasive lung cancer within and between Black and White patients in Tennessee.
A population-based registry data of 42,970 individuals (Black = 4,480 and White = 38,490) diagnosed with invasive lung cancer obtained from the Tennessee Cancer Registry, 2005-2015, was analyzed. We conducted bivariate ANOVA tests to examine the difference in time to treatment initiation among independent factors, and multivariable Cox proportional hazard models to identify independent factors that influence median time to treatment initiation after diagnosis.
When considering the estimate of the proportion of time to treatment initiation based on the combined influence of all independent factors (sex, age, race, marital, county of residence, health insurance, cancer stage, and surgical treatment), Black patients were generally more at risk of delayed treatment compared to Whites. Black patients aged <45 years (adjusted hazard ratio [aHR] = 1.40; 95% confidence interval [CI] = 1.01-1.94) and married White patients (aHR = 1.13; 95% CI = 1.07-1.18) had the highest increased risk of late treatment among their respective racial subgroups. In the general sample, patients with private health insurance had (aHR = 1.08; 95% CI = 1.01-1.16) higher risk of late treatment beyond 2.7 weeks compared to self-pay/uninsured patients. This was consistent among both Black and White subsamples. Patients with localized and regional lung cancer stages had a decreased risk of delayed treatment compared to those diagnosed at the distant stage among both Black and White patients.
Black patients were often at greater risk of late initiation of treatment for invasive lung cancer in Tennessee. Additional research is needed to understand factors influencing time to treatment initiation for Black patients in Tennessee. Further, cancer care resources are needed in Black communities to ensure timely treatment of invasive lung cancer, reduce disparities, and promote equitable care for all cancer patients.
肺癌早期治疗已被证明可提高患者生存率。本研究调查田纳西州黑人和白人患者在侵袭性肺癌治疗开始时间方面的差异，包括群体内部及群体之间的差异。
分析了2005 - 2015年从田纳西癌症登记处获取的42970例被诊断为侵袭性肺癌患者的基于人群的登记数据（黑人 = 4480例，白人 = 38490例）。我们进行了双因素方差分析测试，以检验独立因素在治疗开始时间上的差异，并使用多变量Cox比例风险模型来确定影响诊断后治疗开始中位时间的独立因素。
基于所有独立因素（性别、年龄、种族、婚姻状况、居住县、医疗保险、癌症分期和手术治疗）的综合影响来考虑治疗开始时间比例的估计时，与白人相比，黑人患者通常更有延迟治疗的风险。年龄<45岁的黑人患者（调整后风险比[aHR]=1.40；95%置信区间[CI]=1.01 - 1.94）和已婚白人患者（aHR = 1.13；95% CI = 1.07 - 1.18）在各自种族亚组中延迟治疗的风险增加最高。在总体样本中，与自费/未参保患者相比，拥有私人医疗保险的患者在超过2.7周后延迟治疗的风险更高（aHR = 1.08；95% CI = 1.01 - 1.16）。这在黑人和白人子样本中都是一致的。在黑人和白人患者中，与远处分期诊断的患者相比，局限性和区域性肺癌分期的患者延迟治疗的风险降低。
在田纳西州，黑人患者侵袭性肺癌延迟治疗的风险通常更高。需要进一步研究以了解影响田纳西州黑人患者治疗开始时间有影响的因素。此外，黑人社区需要癌症护理资源，以确保侵袭性肺癌的及时治疗减少差异，并促进所有癌症患者的公平护理。
