title: Race, insurance type, and stage of presentation among lung cancer patients.
abstract: The purpose of this study was to determine whether African-American lung cancer patients are diagnosed at a later stage than white patients, regardless of insurance type. The relationship between race and stage at diagnosis by insurance type was assessed using a Poisson regression model, with relative risk as the measure of association. The setting of the study was a large tertiary care cancer center located in the southeastern United States. Patients who were diagnosed with lung cancer between 2001 and 2010 were included in the study. A total of 717 (31%) African-American and 1,634 (69%) white lung cancer patients were treated at our facility during the study period. Adjusting for age, sex, and smoking-related histology, African-American patients were diagnosed at a statistically significant later stage (III/IV versus I/II) than whites for all insurance types, with the exception of Medicaid. Our results suggest that equivalent insurance coverage may not ensure equal presentation of stage between African-American and white lung cancer patients. Future research is needed to determine whether other factors such as treatment delays, suboptimal preventive care, inappropriate specialist referral, community segregation, and a lack of patient trust in health care providers may explain the continuing racial disparities observed in the current study.
authors: Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC 27834 USA ; Leo Jenkins Cancer Center, Brody School of Medicine, East Carolina University, Greenville, NC USA.
authors: Jimmy T
authors: JT
authors: Efird
authors: Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC 27834 USA.
authors: Hope
authors: H
authors: Landrine
authors: Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC 27834 USA.
authors: Kristin Y
authors: KY
authors: Shiue
authors: Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC USA.
authors: Wesley T
authors: WT
authors: O'Neal
authors: Department of Radiation Oncology, Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH USA.
authors: Tarun
authors: T
authors: Podder
authors: Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA.
authors: Julian G
authors: JG
authors: Rosenman
authors: Department of Radiation Oncology, Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH USA.
authors: Tithi
authors: T
authors: Biswas
keywords: Diagnosis; Disparity; Lung cancer; Race