Non-Small Cell Lung Cancer Survival by Race and Ethnicity in California, 2014-2019 Differences by Sex and Smoking...

Lung cancer is currently the leading cause of cancer-related death. There are gaps in knowledge regarding survival patterns according to sex and smoking status across racial and ethnic groups.

Are there mortality differences according to race/ethnicity among individuals diagnosed with lung cancer in California when stratified by sex and smoking status?

Non-small cell lung cancer (NSCLC) cases diagnosed from 2014 through 2019 from the California Cancer Registry, a population-based cancer surveillance system, were analyzed. Using Cox regression models, hazard ratios (HRs) were estimated for NSCLC mortality according to race and ethnicity, stratified by sex and smoking status and adjusted for sociodemographic and clinical variables.

Among 28,854 female individuals, every racial and ethnic group had an HR < 1 compared with non-Hispanic White (NHW) individuals, with the exception of Native Hawaiian and Pacific Islander and American Indian and Alaskan Native (AIAN) populations, who had comparable mortality. Non-Hispanic Black, Hispanic, and Chinese female individuals had lower mortality relative to NHW female individuals, with HRs of 0.94 (95% CI, 0.89-0.99), 0.89 (95% CI, 0.85-0.93), and 0.82 (95% CI, 0.76-0.88), respectively. Among 29,499 male individuals, every racial and ethnic group exhibited a lower HR, compared with NHW male individuals, with the exception of Japanese (HR, 1.14; 95% CI, 0.99-1.31) and AIAN (HR, 1.15; 95% CI, 0.96-1.38) male individuals. Vietnamese female individuals who had never smoked had lower mortality (HR, 0.80; 95% CI, 0.69-0.92) relative to NHW female individuals. Chinese male individuals who had never smoked had lower mortality (HR, 0.83; 95% CI, 0.71-0.97) compared with NHW male individuals who had never smoked.

In this population-based study of NSCLC, we found mortality differences across racial/ethnic groups when accounting for sex and smoking status. Further research focused on mortality differences in NSCLC stratified according to race and ethnicity should focus on social determinants of health and health care access factors.