Abstract 4831: Racialized economic segregation and disparities in late-stage diagnosis, treatment and mortality among patients with non-small cell lung cancer

Abstract

Abstract Importance: Little is known about the impact of residential segregation on early detection, treatment, and prognosis among patients with non-small cell lung cancer (NSCLC), a predominant type of lung cancers. Objective: To examine the associations of racialized economic segregation with the risks of late-stage diagnosis, non-adherence to guideline-recommended treatment, and mortality among non-Hispanic White (NHW) patients and non-Hispanic Black (NHB) patients with NSCLC. Methods: This population-based retrospective cohort study included patients with NSCLC as a first primary malignancy diagnosed at age 20 and older between January 2007 and December 2015, followed through December 2016, and identified from the Surveillance, Epidemiology, and End Results (SEER) dataset released in April 2019. County-level racialized economic segregation was estimated using the Index of Concentration at the Extremes (ICE). We used multilevel logistic regression and multilevel Cox regression accounting for county-level clustering to estimate odds ratios (ORs) for late-stage diagnosis and non-adherence to guideline-recommended treatment, and hazard ratios (HRs) for overall mortality and lung cancer-specific mortality. Results: Of 203, 441 patients, 85.8% were NHW and 14.2% were NHB. Compared with patients living in the most privileged (lowest ICE quintile―segregated, high-income NHW) counties, patients living in the least privileged (highest ICE quintile―segregated, low-income NHB) counties had higher risks of late-stage diagnosis (OR=1.09, 95% CI: 1.02-1.16; Ptrend <.001), non-adherence to guideline-recommended treatment (OR=1.28, 95% CI: 1.16-1.41; Ptrend <.0001), lung cancer-specific mortality (HR=1.10, 95% CI: 1.07-1.14; Ptrend <.0001), and overall mortality (HR=1.12, 95% CI: 1.09-1.16; Ptrend <.0001). The association of segregation with treatment underutilization was stronger in NHW patients than NHB patients (Pinteraction =0.02). There was no significant difference in the segregation-related risk of late-stage diagnosis, lung cancer-specific mortality, or overall mortality between NHW and NHB patients. Conclusions: Living in segregated, low-income NHB counties was associated with increased risks of late-stage diagnosis, suboptimal treatment, and mortality among patients with NSCLC. Future research should investigate contributors to the adverse impact of residential segregation on lung cancer care and outcomes. Citation Format: Pratibha Shrestha, Min Lian, Ying Liu. Racialized economic segregation and disparities in late-stage diagnosis, treatment and mortality among patients with non-small cell lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4831.