Racial disparities and survival for nonsmall-cell lung cancer in a large cohort of black and white elderly patients.
BACKGROUND
This study aimed to examine disparities in survival and associated factors for patients with nonsmall-cell lung cancer (NSCLC) and to determine whether racial disparities varied over time (1991-1995, 1996-1999, and 2000-2002).


METHODS
The authors studied 70,901 patients aged>or=65 years with stage I-IV NSCLC identified from Surveillance, Epidemiology, and End Results/Medicare data. Multivariate time-to-event survival analyses were completed using Cox proportional regression modeling.


RESULTS
The 5-year observed lung cancer-specific survival rates were 52.7% for whites and 47.5% for blacks with stage I-II disease, and 17.7% and 19.6% for whites and blacks, respectively at stages III-IV. After controlling for standard treatment, socioeconomic status (SES), and other factors, there were no significant differences in all-cause mortality, or lung cancer-specific mortality between black and white patients with stage I-II or III-IV lung cancer. However, blacks had an increased risk for overall all-cause mortality at stage I-IV (hazard ratio [HR], 1.24; 95% confidence interval, 1.13-1.35), and during 2000-2002 at stage III-IV for all-cause mortality (HR, 1.22; 95% CI, 1.02-1.47) and lung cancer-specific mortality (HR, 1.24; 95% CI,1.01-1.53). Standard treatment was significantly associated with increased survival, whereas poor SES was associated with increased mortality.


CONCLUSIONS
There were no significant differences in survival between blacks and whites with NSCLC within stage stratifications after adjusting for covariates, except for black patients at overall stage for all-cause mortality and at stage III-IV diagnosed in 2000-2002. Receiving stage-specific evidence-based standard therapy was associated with significantly increased survival.
Hardy
Dale
D
Division of Epidemiology and Disease Control, The University of Texas School of Public Health, Department of Surgical Oncology, Houston, Texas 77030, USA. dale.s.hardy@uth.tmc.edu
Xia
Rui
R
Liu
Chih-Chin
CC
Cormier
Janice N
JN
Nurgalieva
Zhannat
Z
Du
Xianglin L
XL
D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008175:Lung Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D008297:Male; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D044465:White People