Racial Disparities in Tobacco Smoking-Related Risks for Lung Cancer: A Systematic Review & Meta-analysis

Despite the higher lung cancer incidence among Black individuals, existing evidence on racial disparities in smoking-related lung cancer risk remains limited. This review aims to examine differences in smoking-related lung cancer risk between Black and White individuals.

We conducted a systematic review and meta-analysis of U.S.-based observational studies from 1964 to June 2024. Eligible studies examined lung cancer incidence as the primary outcome and reported race-specific estimates for smoking-related risk. Meta-analysis was used to compare lung cancer risk across racial groups by smoking status (current/former/ever vs. never).

Of 460 abstracts screened, 36 met inclusion criteria, and 11 articles were included in the meta-analysis. Individuals who currently smoke had greater odds of developing lung cancer compared to those who never smoked (OR = 15.52 (95% CI 13.98-17.23)). Similarly, individuals who formerly smoked had greater odds of developing lung cancer compared to those who never smoked (OR = 6.36 (95% CI 5.73-7.07)). In the weighted meta-analysis model, we did not demonstrate significant odds of incident lung cancer cases by race, irrespective of smoking status.

Our findings did not provide statistical evidence of a difference in smoking-related lung cancer risk by race, though precision was limited, particularly for Black participants. Future research should evaluate pack-years and other risk factors to elucidate differences in smoking behaviors among high-risk populations.