Racial and Gender Differences in Lung Cancer Surgery Among Black and White Patients at a Single Institution

Racial disparities in lung cancer persist, with Black men experiencing worse survival. Although structured lung cancer screening (LCS) programs can achieve equitable surgical access, it is unclear whether this extends to broader populations outside of screening. We examined racial and gender differences in lung cancer resection and postoperative outcomes.

Patients undergoing resection for primary lung cancer (2006-2021) were identified from a single-institution database. Neighborhood-level deprivation was assigned by geocoding residential addresses using the patient deprivation index. Demographics and outcomes were compared between Black and White patients. Cox proportional hazards regression and subgroup analyses by race and gender were conducted.

Among 661 patients (108 Black and 549 White), Black patients had higher tobacco exposure (P = 0.01, P = 0.04), lower median income (P < 0.01), and a higher deprivation index (P < 0.01). Black patients were more likely than White patients to have lung cancer diagnosed through LCS (P = 0.01), with this association driven by a higher proportion Black women compared to Black men (P = 0.37). Among patients undergoing resection, Black men represented the smallest race and gender subgroup (P = 0.04). Preoperative comorbidities, surgical approach, and resection type were similar between races. Postoperative events and mortality also did not differ (P > 0.05).

Black men accounted for the smallest proportion of patients undergoing lung cancer resection in this single-institution cohort. Postoperative outcomes and survival were similar across race groups. Targeted interventions to enhance LCS and surgical access may reduce unequal representation particularly for Black men.