Stage-adjusted lung cancer survival does not differ between low-income Blacks and Whites.
BACKGROUND
Few lung cancer studies have focused on lung cancer survival in underserved populations. We conducted a prospective cohort study among 81,697 racially diverse and medically underserved adults enrolled in the Southern Community Cohort Study throughout an 11-state area of the Southeast from March 2002 to September 2009.


METHODS
Using linkages with state cancer registries, we identified 501 incident non-small-cell lung cancer cases. We applied Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for subsequent mortality among black and white participants.


RESULTS
The mean observed follow-up time (the time from diagnosis to death or end of follow-up) was 1.25 years (range, 0-8.3 years) and 75% (n = 376) of cases died during follow-up. More blacks were diagnosed at distant stage than whites (57 versus 45%; p = 0.03). In multivariable analyses adjusted for pack-years of smoking, age, body mass index, health insurance, socioeconomic status and disease stage, the lung cancer mortality HR was higher for men versus women (HR = 1.41; 95% CI, 1.09-1.81) but similar for blacks versus whites (HR = 0.99; 95% CI, 0.74-1.32).


CONCLUSIONS
These findings suggest that although proportionally more blacks present with distant-stage disease there is no difference in stage-adjusted lung cancer mortality between blacks and whites of similar low socioeconomic status.
*Departments of Thoracic Surgery and Medicine, †Division of Epidemiology, Department of Medicine, ‡Institute for Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; §Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee; ‖International Epidemiology Institute, Rockville, Maryland; and ¶Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
Melinda C
MC
Aldrich
Eric L
EL
Grogan
Heather M
HM
Munro
Lisa B
LB
Signorello
William J
WJ
Blot
D000328:Adult; D000368:Aged; D044383:Black People / Q000706:statistics & numerical data*; D002289:Carcinoma, Non-Small-Cell Lung / Q000208:ethnology / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012959:Socioeconomic Factors; D015996:Survival Rate; D014481:United States / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American