Healthcare system/provider biases and differences in patient characteristics are thought to be prevailing factors underlying racial disparities. The influence of these factors on the receipt of care would likely be mitigated among patients recommended optimal therapy. We hypothesized that there would be no significant evidence of racial disparities among early-stage lung cancer patients recommended surgical therapy.
Retrospective cohort study.
Patients and Setting
Patients within the Surveillance, Epidemiology, and End-Results-Medicare database diagnosed with stage I or II lung cancer between 1992 and 2002 (follow-up through 2005).
Main Outcome Measures
Receipt of lung resection and overall survival.
Among 17,739 patients recommended surgical therapy—mean (SD) age 75 (5) years, 89% white, 6% black—blacks less frequently underwent resection compared to whites (69% versus 83%, p<0.001). After adjustment, black race was associated with a lower odds of receiving surgical therapy (OR 0.43, 99% CI 0.36-0.52). Unadjusted 5-year survival rates were lower for blacks compared to whites (36% versus 42%, p<0.001). After adjustment, there was no significant association between race and death (HR 1.03, 99% CI 0.92-1.14) despite a 14% difference in receipt of optimal therapy.
Even among patients recommend surgical therapy, blacks underwent lung resection less often then whites. Unexpectedly, racial differences in the receipt of optimal therapy did not appear to affect outcomes. These findings suggest that distrust, beliefs and perceptions about lung cancer and its treatment, and limited access to care (despite insurance) might have a more dominant role in perpetuating racial disparities than previously recognized.