Race, insurance type, and stage of presentation among lung cancer patients.

Jimmy T Efird,Hope Landrine,Julian G Rosenman,Tarun Podder,Tithi Biswas,Kristin Y Shiue,Wesley T O’Neal

doi:10.1186/2193-1801-3-710

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.

Highlights

Lung cancer is the leading cause of cancer deaths in the United States, with mortality rates per 100,000 being higher among African-American (AA) (52.2) than white (49.2) patients (U.S Cancer Statistics Working Group 2013; Elk and Landrine 2012)
This disparity may be explained by racial differences in health insurance coverage wherein AAs are more likely to be underinsured or have no health insurance (Kirby and Kaneda 2010)
A total of 717 (31%) AA and 1,634 (69%) white lung cancer patients were treated at our center during the study period (Table 1)

Summary

Introduction

Lung cancer is the leading cause of cancer deaths in the United States, with mortality rates per 100,000 being higher among African-American (AA) (52.2) than white (49.2) patients (U.S Cancer Statistics Working Group 2013; Elk and Landrine 2012). While a decline in lung cancer mortality has been observed in the general population, rates remain high in racial and ethnic minorities (Berger et al 2007). AA lung cancer patients are more likely to be diagnosed at a later stage than whites (Schwartz et al 2003; Hardy et al 2009; Halpern et al 2008). This disparity may be explained by racial differences in health insurance coverage wherein AAs are more likely to be underinsured or have no health insurance (Kirby and Kaneda 2010).

Objectives

Results

Conclusion