title: Important prognostic factors for lung cancer in tobacco predominant Eastern North Carolina: study based on a single cancer registry.
abstract: BACKGROUND
  It is known that lung cancer incidence and mortality rate are higher in African Americans (AA) than whites. In Eastern North Carolina, there is a higher percentage of AA population than the national average (30.2% vs. 12.4%) and a higher incidence of lung cancer in this region. We investigated demography and survival of lung cancer patients diagnosed and treated in a single institution.
  
  
  METHODS
  The study includes 2351 patients diagnosed with lung cancer between 2001 and 2010 at East Carolina University. AA and whites were compared by age, sex, race, stage, histology, smoking history and insurance information using chi-square analyses. Patient survival was modeled using Cox proportional hazards regression (SAS version 9.2).
  
  
  RESULTS
  The distribution of lung cancer was 70% in whites and 30% in AA. The proportion of AA and whites differed significantly for age, sex, histology, stage, and insurance. Patients aged > 70 (p < 0.0001) and 51-70 (p = 0.0064) died sooner than those ≤ 50 years old. Compared with squamous cell, SCLC had inferior survival (HR = 2.0, 95% CI = 1.7-2.3). Privately insured patients survived longer than those with medicare (p < 0.0001), medicaid (p = 0.0009), or no insurance (p < 0.0001). The survival disadvantage for medicaid (p = 0.0076) and no insurance (p = 0.0033) persisted on multivariable analysis. Race was not a significant predictor of survival on multivariable analysis (p = 0.66).
  
  
  CONCLUSIONS
  This is one of the largest lung cancer patient populations from a single institution showing demographic differences between the two races with similar survival outcome. Age, histology and type of insurance were strong predictors of survival outcome. Older age, small cell histology and medicaid and no insurance had significantly shorter overall survival.
authors.affiliation: Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH 44106, United States. Electronic address: tithi.biswas@uhhospitals.org.
authors.forename: Tithi
authors.initials: T
authors.lastname: Biswas
authors.affiliation: Division of Hematology Oncology, Department of Medicine, Leo Jenkins Cancer Center, East Carolina University, Greenville, NC 27834, United States.
authors.forename: Paul
authors.initials: P
authors.lastname: Walker
authors.affiliation: Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH 44106, United States.
authors.forename: Tarun
authors.initials: T
authors.lastname: Podder
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, United States.
authors.forename: Julian
authors.initials: J
authors.lastname: Rosenman
authors.affiliation: Center for Health Disparities, Department of Public Health, East Carolina University, Greenville, NC 27834, United States.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Efird
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality*; D000328:Adult; D001741:Black or African American; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D018307:Neoplasms, Squamous Cell / Q000175:diagnosis / Q000401:mortality*; D009657:North Carolina / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D014481:United States; D044465:White People
keywords: Cancer registry; Disparity; Effects of insurance; Histology; Lung cancer; Race