title: Association between race and survival of patients with non--small-cell lung cancer in the United States veterans affairs population.
abstract: BACKGROUND
  Racial disparities in outcomes of non-small-cell lung cancer (NSCLC) patients in the United States are well documented. A retrospective analysis of patients in the Veterans Affairs Central Cancer Registry was conducted to determine whether similar disparities exist in a population with a single-payer, accessible health care system.
  
  
  METHODS
  Demographic data of patients diagnosed with NSCLC between January 1995 and February 2009 were analyzed using Kruskal-Wallis test or the χ(2) test. Multivariate Cox proportional hazards regression analysis was used to compare survival among races.
  
  
  RESULTS
  Of the 82,414 patients, 98% were male, 82% had a smoking history, and 81% were Caucasian. Caucasian individuals had better prognostic features compared with African-American individuals (stage I/II [24% vs. 21%]; Grade I/II [21% vs. 17%]). A larger proportion of Caucasian compared with African-American individuals received stage-appropriate treatment (surgery for stage I [48% vs. 41%; P < .001]; chemotherapy for stage IV [18% vs. 16%; P = .003]). African-American individuals had a lower risk of mortality compared with Caucasian individuals (hazard ratio, 0.94; 95% confidence interval, 0.92-0.96).
  
  
  CONCLUSIONS
  Although African-American patients had a higher stage and grade of NSCLC, they had a better overall survival than Caucasian patients. In a single-payer system with accessible health care, previously described racial differences in lung cancer outcomes were not observed.
authors.affiliation: Department of Internal Medicine, VA Nebraska Western Iowa Health Care System, Omaha, NE; Division of Oncology/Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE. Electronic address: aganti@unmc.edu.
authors.forename: Apar Kishor
authors.initials: AK
authors.lastname: Ganti
authors.affiliation: Department of Internal Medicine, VA Nebraska Western Iowa Health Care System, Omaha, NE; Division of Oncology/Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE; Division of Oncology/Hematology, Department of Internal Medicine, Creighton University Medical Center, Omaha, NE.
authors.forename: Shanmuga P
authors.initials: SP
authors.lastname: Subbiah
authors.affiliation: Division of Oncology/Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Anne
authors.initials: A
authors.lastname: Kessinger
authors.affiliation: Division of Oncology/Hematology, Department of Internal Medicine, Creighton University Medical Center, Omaha, NE.
authors.forename: Wilson I
authors.initials: WI
authors.lastname: Gonsalves
authors.affiliation: Department of Internal Medicine, VA Nebraska Western Iowa Health Care System, Omaha, NE; Division of Oncology/Hematology, Department of Internal Medicine, Creighton University Medical Center, Omaha, NE.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Silberstein
authors.affiliation: Division of Oncology/Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Fausto R
authors.initials: FR
authors.lastname: Loberiza
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D018287:Carcinoma, Large Cell / Q000208:ethnology / Q000401:mortality / Q000473:pathology / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000208:ethnology / Q000401:mortality / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Non–small-cell lung cancer; Outcomes; Prognosis; Race; Survival