African American lung cancer patients who live in low-income, segregated neighborhoods are less likely than their peers in more-affluent communities to get surgery that can add years to their lives, a study suggests.
A greater proportion of black patients than whites died during the study, and African Americans typically had fewer months of survival after their diagnosis, the study also found.
“Our survival analysis showed black patients who lived in areas with both high levels of poverty and segregation had lower survival rates, even after we controlled for the effect of receiving surgery,” said lead study author Asal Mohamadi Johnson, a researcher at Stetson University in DeLand, Fla.
To assess disparities in lung cancer treatment and outcomes, Johnson and colleagues examined data on nearly 8,300 patients in a Georgia cancer registry from 2000 to 2009. They followed the patients until death or Jan. 1, 2012.
Overall, black patients had 43 percent lower odds of receiving surgery than white patients. But this gap disappeared after adjusting for the combination of race, neighborhood-level poverty and segregation, the researchers report in the journal Cancer Epidemiology, Biomarkers and Prevention.
They used census records to rank patients’ neighborhoods into four groups based on income levels and the degree of segregation.
For black patients, neighborhood segregation was the strongest predictor of whether they would receive surgery. Compared with those in the least-segregated areas, patients in the most-segregated areas were 65 percent less likely to receive surgery.
By contrast, education levels in the neighborhood were the biggest predictor of surgery for white patients. Whites in the least-educated areas were 48 percent less likely to get surgery than their peers in the most-educated communities.
Black patients also had lower five-year survival rates than white patients, but this gap disappeared after controlling for whether people received surgery. This suggests that the disparity in survival may be explained by differences in receipt of surgery, the authors conclude.
Limitations of the study include a lack of data on individual patients’ social or economic status, medical conditions or insurance, the authors note. They also lacked data on the cause of death, meaning that some people may have died of causes unrelated to lung cancer.
Even so, the study adds to a growing body of research exploring the root causes of racial disparities in health care, said Caitlin Murphy, an epidemiologist at the University of North Carolina at Chapel Hill who was not involved in the study.
“The poor outcomes we frequently observe in black patients are likely due to a variety of patient-, provider- and system-level factors,” Murphy said by email. “This study adds to our knowledge of how the larger neighborhood context may also influence the receipt of quality cancer care.”
