Health Disparities
Racial/Ethnic Disparities in Non-small Cell Lung Cancer Stage at Diagnosis: A Population-Based Study Qinran Liu* Qinran Liu Tulay Koru-Sengul Paulo S. Pinheiro
Background
The prognosis of lung cancer significantly relies on accurate and timely staging. However, notable disparities in staging and outcomes among different racial/ethnic groups exist. This population-based study aims to identify factors contributing to these disparities in the stage of non-small cell lung cancer (NSCLC) diagnoses, focusing on Hispanic ethnic subgroups.
Methods
Incident cases diagnosed from 2005–2018 were extracted from the Florida State Cancer Registry. Stage was categorized as resectable (Stage I-IIIA) or nonresectable (Stage IIIB/IIIC/IV). Multivariable logistic regression models were used to assess the association between race/ethnicity and stage at diagnosis, adjusted for socioeconomic, smoking status, and clinical factors. Regional stratification was further conducted (South Florida vs. Rest of Florida).
Results
Among 157,034 NSCLC patients, 81.0% were White, 8.3% Black, and 9.2% Hispanic; 43.2% were diagnosed at a resectable stage. Compared to White patients, Black patients had a 12% higher likelihood of non-resectable stage diagnosis (ORadj=1.12; 95% CI: 1.11-1.14). In age-adjusted models, all Hispanic patients and their subgroups demonstrated higher odds of non-resectable stage at diagnosis compared to White patients; however, in fully adjusted models, this association was significant only for Central Americans (ORadj=1.41; 95% CI: 1.35-1.47). Notably, regional differences were remarkable; Hispanic patients in South Florida showed better staging outcomes compared to those in the rest of Florida (South Florida: ORadj=0.95; 95% CI: 0.94-0.97 vs. Rest of Florida: ORadj=1.09; 95% CI: 1.07-1.10).
Conclusion
The study highlights significant disparities in NSCLC staging among Black and certain Hispanic groups. The marked regional differences between South Florida and the rest of the state underscore the importance of considering intra-state geographic and cultural factors in lung cancer prevention and control strategies, as well as in enhancing health access.