Mediators of Racial Inequities in Non-Small Cell Lung Cancer Care

Area of Science:

• Oncology
• Health Services Research
• Health Equity

Background:

• Black patients with non-small cell lung cancer (NSCLC) face disparities in diagnosis and treatment compared to White patients.
• Structural racism is a potential driver of these racial inequities in NSCLC care.

Purpose of the Study:

• To identify factors related to structural racism that mediate the association between race and NSCLC care.
• To analyze how socioeconomic status and healthcare access influence racial disparities in NSCLC diagnosis, treatment, and survival.

Main Methods:

• Utilized Surveillance, Epidemiology, and End Results-Medicare data for non-Hispanic Black and White patients aged 67+ diagnosed with NSCLC (2013-2019).
• Examined outcomes including diagnosis stage, stage-appropriate evaluation and treatment, two-year survival, and "optimal" care.
• Estimated indirect effects of mediators on the association between race and outcomes.

Main Results:

• Medicare-Medicaid dual eligibility (individual SES) was the largest mediator for most outcomes, explaining 13.6%–25.0% of racial disparities.
• Influenza vaccine receipt (healthcare access) showed the second largest mediating effects on diagnosis stage, treatment, and optimal care.
• Neighborhood-level SES accounted for 9%–16% of racial inequities across all care phases.

Conclusions:

• Individual and neighborhood-level structural factors partially explain racial inequities in NSCLC care.
• The impact of these factors varies depending on the specific phase of cancer care.
• Interventions to address NSCLC disparities must be tailored to different stages of care.