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

Farjah, Farhood and Wood, Douglas E and Yanez, N David and Vaughan, Thomas L and Symons, Rebecca Gaston and Krishnadasan, Bahirathan and Flum, David R (2009) Racial disparities among patients with lung cancer who were recommended operative therapy. Archives of surgery (Chicago, Ill. : 1960), 144 (1). pp. 14-18. ISSN 1538-3644

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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.

Item Type: Article
Additional Information: This article is available to subscribers only via the URL above.
DOI: 10.1001/archsurg.2008.519
PubMed ID: 19153319
PMCID: PMC2688646
Grant Numbers: T32 CA009168-30, F32 CA130434-01
Keywords or MeSH Headings: African Americans; Aged; Aged, 80 and over; Cohort Studies; European Continental Ancestry Group; Female; Healthcare Disparities/statistics & numerical data; Humans; Lung Neoplasms/mortality/surgery; Male; Pneumonectomy/statistics & numerical data; Retrospective Studies; Survival Rate;
Subjects: Diseases > Solid tumors > Lung cancer
Health Care
Therapeutics > Surgical Procedures
Depositing User: Library Staff
Date Deposited: 01 Apr 2009 18:46
Last Modified: 14 Feb 2012 14:42

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