Racial Disparity and Social Determinants in Receiving Timely Surgery Among Stage I–IIIA Non-small Cell Lung Cancer Patients in a U.S. Southern State

Abstract

Delayed surgery is associated with worse lung cancer outcomes. Social determinants can influence health disparities. This study aimed to examine the potential racial disparity and the effects from social determinants on receipt of timely surgery among lung cancer patients in Louisiana, a southern state in the U.S. White and black stage I–IIIA non-small cell lung cancer patients diagnosed in Louisiana between 2004 and 2016, receiving surgical lobectomy or a more extensive surgery, were selected. Diagnosis-to-surgery interval >6 weeks were considered as delayed surgery. Social determinants included marital status, insurance, census tract level poverty, and census tract level urbanicity. Multivariable logistic regression and generalized multiple mediation analysis were conducted. A total of 3,616 white (78.9%) and black (21.1%) patients were identified. The median time interval from diagnosis to surgery was 27 days in whites and 42 days in blacks (P < 0.0001). About 28.7% of white and 48.4% of black patients received delayed surgery (P < 0.0001). Black patients had almost two-fold odds of receiving delayed surgery than white patients (adjusted odds ratio: 1.91; 95% confidence interval: 1.59–2.30). Social determinants explained about 26% of the racial disparity in receiving delayed surgery. Having social support, private insurance, and living in census tracts with lower poverty level were associated with improved access to timely surgery. The census tract level poverty level a stronger effect on delayed surgery in black patients than in white patients. Tailored interventions to improve the timely treatment in NSCLC patients, especially black patients, are needed in the future.

Effect of an Antiracism Intervention on Racial Disparities in Time to Lung Cancer Surgery

“…However, given near universal health coverage for our study population, secondary insurance type would likely have a small effect on the timeliness of surgery. 45 We also did not assess the distance from patient home or census tract to the site of care, a potentially important indicator for timely care, 46,47 as geo-coded data were not collected in the primary study. There were also limitations related to the sample size and study design.…”

Association of Allostatic Load With Overall Mortality Among Patients With Metastatic Non–Small Cell Lung Cancer

“… 5 Social determinants of health are multilevel factors such as socioeconomic and political policy contexts, socioeconomic position, psychosocial factors, behaviors, biological factors, and living and working conditions that predispose to disease and drive inequities in clinical outcomes. 6 For patients with lung cancer, adverse SDHs such as delay in surgical care, 7 being unmarried, 8 lower socioeconomic status, 9 and continuing depressive symptoms 10 have been associated with higher mortality. Nonetheless, biological correlates for adverse SDHs and their implications for mortality are unclear and less studied.…”

“…JAMA Network Open. 2022;5(7):e2221626. doi:10.1001/jamanetworkopen.2022.21626 (Reprinted) July 7, 2022 13/13 Downloaded From: https://jamanetwork.com/ on 07/17/2022…”

Disparities in time to start of definitive radiation treatment for patients with locally advanced cervical cancer

“…Additionally, there is a disparity in incidence of locally advanced cervical cancer and subsequent mortality in non-Hispanic black women and Hispanic women compared with non-Hispanic white women 11–13. For other cancer sites, black and Hispanic women are well documented to undergo longer wait times for definitive treatment than their white counterparts 14–16. To further elucidate quality improvement metrics at our institution and worldwide, we investigated factors that may influence start time to chemoradiation or radiation and the subsequent impact of time to treatment on recurrence and survival outcomes.…”