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Racial Disparities in Lung Cancer Stage of Diagnosis among Adults Living in the Southeastern U.S.

Chest 2022 November 24
BACKGROUND: Black Americans are diagnosed at later stage of lung cancer more often than White Americans. We undertook a population-based study to identify factors contributing to racial disparities in lung cancer stage of diagnosis among low-income adults.

RESEARCH QUESTION: Which multilevel factors contribute to racial disparities in stage of lung cancer at diagnosis?

STUDY DESIGN AND METHODS: Incident lung cancers from the prospective observational Southern Community Cohort Study were identified by linkage with state cancer registries in 12 southeastern states. Logistic regression shrinkage techniques were implemented to identify individual-level and area-level factors associated with distant stage diagnosis. A subset of participants who responded to psychosocial questions (e.g., racial discrimination experiences) were evaluated to determine if model predictive power improved.

RESULTS: We identified 1,572 incident lung cancer cases with available lung cancer stage (64% self-identified as Black and 36% identified as White). Overall, Black participants with lung cancer had greater unadjusted odds of distant stage diagnosis compared to White participants (odds ratio (OR)=1.29, 95% confidence interval (CI): 1.05-1.59). Greater neighborhood area deprivation was associated with distant stage diagnosis (OR=1.58, 95% CI: 1.19-2.11). After controlling for individual- and area-level factors, there was no significant difference in distant stage disease for Black versus White participants. However, participants with COPD had lower odds of distant stage diagnosis in the primary model (OR=0.72, 95% CI: 0.53-0.98). Interesting and complex interactions were observed. The subset analysis model with additional variables for racial discrimination experiences had slightly greater predictive power than the primary model.

INTERPRETATION: Reducing racial disparities in lung cancer stage at presentation will require interventions on both structural and individual-level factors.

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