Disparities in Stage at Presentation among Hispanic and Latinx Patients with Non-Small Cell Lung Cancer

Abstract

Hispanic and Latinx people in the United States comprise 19% of the population and are the fastest-growing ethnic group. However, prior studies in non-small cell lung cancer (NSCLC) often analyze these diverse communities in aggregate. We aimed to identify differences in NSCLC stage at diagnosis in the US population, with a particular focus on disaggregated Hispanic populations. Data from the National Cancer Database (NCDB) from 2004 to 2018 were used to identify patients with primary NSCLC. Individuals were disaggregated by racial and ethnic subgroup and Hispanic country of origin. Ordinal logistic regression adjusting for age, facility type, income, educational attainment, comorbidity index, insurance, and year of diagnosis was used to create adjusted odds ratios (aORs), with higher odds representing diagnosis at later-stage NSCLC. Out of 1,773,177 patients with NSCLC, 50,512 were Hispanic/Latinx (2.8%). Hispanic patients were less likely to be insured (χ2 P<0.001) and were more likely to live in lower-income ZIP codes (χ2 P<0.001). Hispanic patients were more likely to be diagnosed with metastatic disease compared to non-Hispanic White (NHW) patients: 47% for Hispanic Black (HB), 46% Hispanic White (HW), and 44.3% of Hispanic other (HO) patients vs. 39.1% of NHW patients (aORs for later-stage disease with NHW as reference: HW 1.23, HB 1.26, HO 1.14, P<0.001 for all). Upon disaggregation by country of origin, 51.4% of Mexican, 41.7% of Puerto Rican, 44.6% of Cuban, 50.8% of South or Central American, 48.4% of Dominican, and 45.6% of Other Hispanic patients were diagnosed with metastatic disease, compared with 39.1% of NHW patients. Conversely, 20.2% of Mexican, 26.9% of Puerto Rican, 24.2% of Cuban, 22.5% of South or Central American, 23.7% of Dominican, and 24.5% of Other Hispanic patients were diagnosed with stage I disease, compared with 30.0% of NHW patients. On multivariable analysis, all Hispanic groups were more likely to present with later-stage NSCLC than NHW patients, with the greatest odds for Mexican patients (aOR 1.45, P<0.001). Hispanic/Latinx patients with non-small cell lung cancer were more likely to be diagnosed with more advanced disease compared with non-Hispanic White patients. Disparities persisted upon disaggregation by both race and country of origin, with over half of Mexican patients with metastatic disease at diagnosis. Disparities amongst Hispanic groups by race and by country of origin highlight the shortcomings of treating these groups as a monolith and underscore the need for disaggregated research and targeted interventions. Further work should explore differences in exposures, behaviors, and access to care that may underlie these disparities.