Zhao Yong-Sheng, A-Lai Gu-Ha, Long Hang, Zhong Chuan, Lin Yi-Dan
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Respiratory and Critical Medicine, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, China.
J Thorac Dis. 2025 Aug 31;17(8):5509-5523. doi: 10.21037/jtd-2025-333. Epub 2025 Aug 26.
Racial disparities in lung cancer have existed in the United States (US) for many years. No studies have been conducted to elucidate the long-term trends of racial disparities in all-cause and cause-specific deaths in lung cancer patients. Our study aimed to explore trends and potential contributing factors of racial disparities.
From the Surveillance, Epidemiology, and End Results (SEER) Program, we obtained the data of lung cancer patients diagnosed between 2000 and 2019, with follow-up until Dec 31, 2020. The cumulative mortality for Black, White, Asian or Pacific Islander (API), and American Indian or Alaska Native (AIAN) was calculated by diagnostic period and cause of death. By using Cox regression models, we determined the relative [hazard ratio (HR)] racial disparities and contributing factors.
The incidence and mortality rates during 2000-2019 for lung cancer decreased in all racial groups in men and women, especially for Black men. Despite a downward trend in the cumulative risk of death in racial groups, Black and API patients consistently had the highest and lowest mortality rates from 2000 to 2019, with adjusted HR of 1.14 and 0.83, respectively. The Black-White disparities in all-cause mortality narrowed over time, with adjusted HR of 1.18 [95% confidence interval (CI): 1.15-1.20] during 2000-2004 and 1.14 (95% CI: 1.11-1.16) during 2015-2019. Surgery and liver metastasis had the largest effect on Black-White disparities and API-White disparities, respectively.
Our findings reveal persistent racial disparities among lung cancer patients, providing a theoretical basis for interventions to eliminate health disparities.
肺癌方面的种族差异在美国已存在多年。尚未有研究阐明肺癌患者全因死亡和特定病因死亡中种族差异的长期趋势。我们的研究旨在探讨种族差异的趋势及潜在影响因素。
从监测、流行病学和最终结果（SEER）项目中，我们获取了2000年至2019年期间诊断的肺癌患者数据，并随访至2020年12月31日。按诊断时期和死亡原因计算了黑人、白人、亚裔或太平洋岛民（API）以及美国印第安人或阿拉斯加原住民（AIAN）的累积死亡率。通过使用Cox回归模型，我们确定了相对风险比（HR）的种族差异及影响因素。
2000 - 2019年期间，所有种族群体的男性和女性肺癌发病率和死亡率均有所下降，尤其是黑人男性。尽管各种族群体的累积死亡风险呈下降趋势，但2000年至2019年期间，黑人和API患者的死亡率始终最高和最低，调整后的HR分别为1.14和0.83。全因死亡率方面的黑白差异随时间逐渐缩小，2000 - 2004年期间调整后的HR为1.18[95%置信区间（CI）：1.15 - 1.20]，2015 - 2019年期间为1.14（95%CI：1.11 - 1.16）。手术和肝转移分别对黑白差异和API与白人的差异影响最大。
我们的研究结果揭示了肺癌患者中持续存在的种族差异，为消除健康差异的干预措施提供了理论依据。
