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 Compared to black patients living in the least segregated areas,
residents of the most segregated communities were at least 60
percent less likely to receive surgery for non-small cell lung
cancer, the most common form.
A greater proportion of black patients died during the study, and
African Americans typically had fewer months of survival after their
diagnosis than whites, 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, Florida.
“We found it surprising that area level poverty by itself did not
explain differences in survival among black patients, rather its
effect was seen only when combined with segregation,” Johnson added
by email.
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 patients until
death or January 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, online May 2.
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.
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Black patients also had lower five-year survival 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 the 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 some people might 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 wasn’t involved in the study.
“Racial disparities in cancer treatment and outcomes are complex,”
Murphy said by email.
“The poor outcomes we frequently observe in black patients are
likely due to a variety of patient-, provider- and system-level
factors,” Murphy added. “This study adds to our knowledge of how the
larger neighborhood context may also influence the receipt of
quality cancer care.”
SOURCE: http://bit.ly/21x4dcS
Cancer Epidemiol Biomarkers Prev 2016.
[© 2016 Thomson Reuters. All rights
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