Racial disparities among patients with lung cancer who were recommended operative therapy

Farhood Farjah, Douglas E. Wood, Norbert Yanez, Thomas L. Vaughan, Rebecca Gaston Symons, Bahirathan Krishnadasan, David R. Flum

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

Hypothesis: Health care system and 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 who are recommended optimal therapy. We hypothesized that there would be no significant evidence of racial disparities among patients with early-stage lung cancer who are recommended surgical therapy. Design, Setting, and Patients: Retrospective cohort study of patients in the Surveillance, Epidemiology, and End Results-Medicare database who were diagnosed with stage I or II lung cancer between January 1, 1992, and December 31, 2002 (follow-up through December 31, 2005). Main Outcome Measures: Receipt of lung resection and overall survival. Results: Among 17 739 patients who were recommended surgical therapy (mean [SD] age, 75 [5] years; 89% white, 6% black), black patients less frequently underwent resection compared with white patients (69% vs 83%, respectively; P < .001). After adjustment, black race was associated with lower odds of receiving surgical therapy (odds ratio = 0.43; 99% confidence interval, 0.36-0.52). Unadjusted 5-year survival rates were lower for black patients compared with white patients (36% vs 42%, respectively; P < .001). After adjustment, there was no significant association between race and death (hazard ratio = 1.03; 99% confidence interval, 0.92-1.14) despite a 14% difference in receipt of optimal therapy. Conclusions: Even among patients who were recommended surgical therapy, black patients underwent lung resection less often than white patients. 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.

Original languageEnglish (US)
Pages (from-to)14-18
Number of pages5
JournalArchives of Surgery
Volume144
Issue number1
DOIs
StatePublished - Jan 2009
Externally publishedYes

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Lung Neoplasms
Therapeutics
Confidence Intervals
Lung
Medicare
Insurance
Health Personnel
Epidemiology
Cohort Studies
Survival Rate
Retrospective Studies
Odds Ratio
Outcome Assessment (Health Care)
Databases
Delivery of Health Care
Survival

ASJC Scopus subject areas

  • Surgery

Cite this

Farjah, F., Wood, D. E., Yanez, N., Vaughan, T. L., Symons, R. G., Krishnadasan, B., & Flum, D. R. (2009). Racial disparities among patients with lung cancer who were recommended operative therapy. Archives of Surgery, 144(1), 14-18. https://doi.org/10.1001/archsurg.2008.519

Racial disparities among patients with lung cancer who were recommended operative therapy. / Farjah, Farhood; Wood, Douglas E.; Yanez, Norbert; Vaughan, Thomas L.; Symons, Rebecca Gaston; Krishnadasan, Bahirathan; Flum, David R.

In: Archives of Surgery, Vol. 144, No. 1, 01.2009, p. 14-18.

Research output: Contribution to journalArticle

Farjah, F, Wood, DE, Yanez, N, Vaughan, TL, Symons, RG, Krishnadasan, B & Flum, DR 2009, 'Racial disparities among patients with lung cancer who were recommended operative therapy', Archives of Surgery, vol. 144, no. 1, pp. 14-18. https://doi.org/10.1001/archsurg.2008.519
Farjah, Farhood ; Wood, Douglas E. ; Yanez, Norbert ; Vaughan, Thomas L. ; Symons, Rebecca Gaston ; Krishnadasan, Bahirathan ; Flum, David R. / Racial disparities among patients with lung cancer who were recommended operative therapy. In: Archives of Surgery. 2009 ; Vol. 144, No. 1. pp. 14-18.
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abstract = "Hypothesis: Health care system and 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 who are recommended optimal therapy. We hypothesized that there would be no significant evidence of racial disparities among patients with early-stage lung cancer who are recommended surgical therapy. Design, Setting, and Patients: Retrospective cohort study of patients in the Surveillance, Epidemiology, and End Results-Medicare database who were diagnosed with stage I or II lung cancer between January 1, 1992, and December 31, 2002 (follow-up through December 31, 2005). Main Outcome Measures: Receipt of lung resection and overall survival. Results: Among 17 739 patients who were recommended surgical therapy (mean [SD] age, 75 [5] years; 89{\%} white, 6{\%} black), black patients less frequently underwent resection compared with white patients (69{\%} vs 83{\%}, respectively; P < .001). After adjustment, black race was associated with lower odds of receiving surgical therapy (odds ratio = 0.43; 99{\%} confidence interval, 0.36-0.52). Unadjusted 5-year survival rates were lower for black patients compared with white patients (36{\%} vs 42{\%}, respectively; P < .001). After adjustment, there was no significant association between race and death (hazard ratio = 1.03; 99{\%} confidence interval, 0.92-1.14) despite a 14{\%} difference in receipt of optimal therapy. Conclusions: Even among patients who were recommended surgical therapy, black patients underwent lung resection less often than white patients. 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.",
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