Racial disparities in the cause of death among patients with lung cancer in the United States.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

Our findings reveal persistent racial disparities among lung cancer patients, providing a theoretical basis for interventions to eliminate health disparities.