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Original Articles: General Thoracic

Underuse of Surgical Resection for Localized, Non–Small Cell Lung Cancer Among Whites and African Americans in South Carolina

^a Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
^c Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston, South Carolina
^e Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
^b Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
^d South Carolina Office of Research and Statistics, Columbia, South Carolina

Accepted for publication February 21, 2008.

^_* Address correspondence to Dr Esnaola, Department of Surgery, Medical University of South Carolina, 25 Courtenay Dr, Suite 7018 (MSC 295), Charleston, SC 29425 (Email: esnaolan{at}musc.edu).

Presented at the Fifty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 7–10, 2007.

Background: Early studies using Medicare data reported racial disparities in surgical treatment of localized, non–small cell lung cancer. We analyzed the independent effect of race on use of surgical resection in a recent, population-based sample of patients with localized non–small cell lung cancer, controlling for comorbidity and socioeconomic status.

Methods: All cases of localized non–small cell lung cancer reported to our state Cancer Registry between 1996 and 2002 were identified and linked to the Inpatient/Outpatient Surgery Files and 2000 Census. Comorbidity (Romano-Charlson index) was calculated using administrative data codes. Educational level and income were estimated using census data. Characteristics of white and African American patients were compared using ² tests. Odds ratios of resection and 95% confidence intervals were calculated using logistic regression.

Results: We identified 2,506 white and 550 African American patients. African Americans were more likely to be younger, male, not married, less educated, poor, and uninsured or covered by Medicaid (all p < 0.0001), and to reside in rural communities (p = 0.0005). Use of surgical resection across races was lower than previously reported, and African Americans were significantly less likely to undergo surgery compared with whites (44.7% versus 63.4%; p < 0.0001). Even after controlling for sociodemographics, comorbidity, and tumor factors, the adjusted odds ratio for resection for African Americans was 0.43 (95% confidence interval, 0.34 to 0.55).

Conclusions: Underuse of surgical resection for localized, non–small cell lung cancer is a persistent problem, particularly among African Americans. Further studies are urgently needed to identify the patient-, physician-, and health system–related factors underlying these observations and optimize resection rates for non–small cell lung cancer.