Racial Disparities in Lung Cancer Stage of Diagnosis Among Adults Living in the Southeastern United States

BACKGROUND: Black Americans receive a diagnosis at later stage of lung cancer more often than White Americans. We undertook a population-based study to identify factors contributing to racial disparities in lung cancer stage of diagnosis among low-income adults.RESEARCH QUESTION: Which multilevel factors contribute to racial disparities in stage of lung cancer at diagnosis?STUDY DESIGN AND METHODS: Cases of incident lung cancer from the prospective observa-tional Southern Community Cohort Study were identified by linkage with state cancer reg-istries in 12 southeastern states. Logistic regression shrinkage techniques were implemented to identify individual-level and area-level factors associated with distant stage diagnosis. A subset of participants who responded to psychosocial questions (eg, racial discrimination experiences) were evaluated to determine if model predictive power improved.RESULTS: We identified 1,572 patients with incident lung cancer with available lung cancer stage (64% self-identified as Black and 36% self-identified as White). Overall, Black participants with lung cancer showed greater unadjusted odds of distant stage diagnosis compared with White participants (OR,1.29; 95% CI, 1.05-1.59). Greater neighborhood area deprivation was associated with distant stage diagnosis (OR, 1.58; 95% CI, 1.19-2.11). After controlling for individual-and area-level factors, no significant difference were found in distant stage disease for Black vs White participants. However, participants with COPD showed lower odds of distant stage diagnosis in the primary model (OR, 0.72; 95% CI, 0.53-0.98). Interesting and complex interactions were observed. The subset analysis model with additional variables for racial discrimination experi-ences showed slightly greater predictive power than the primary model. INTERPRETATION: Reducing racial disparities in lung cancer stage at presentation will require interventions on both structural and individual-level factors.CHEST 2023; 163(5):1314-1327

Automated summary

This study identified factors contributing to racial disparities in lung cancer stage of diagnosis among low-income adults. Individual-level and area-level factors were found to be associated with distant stage diagnosis. The predictive power of the model slightly improved when psychosocial factors were considered. Interventions on both structural and individual-level factors are necessary to reduce racial disparities in lung cancer stage at presentation.