Published ahead of print on February 25, 2005, doi:10.1164/rccm.200411-1475OC Am. J. Respir. Crit. Care Med., Volume 171, Number 10, May 2005, 1158-1163 A more recent version of this article appeared on May 15, 2005
Submitted on November 4, 2004 Ethnic Disparities in the Treatment of Stage I Non-small Cell Lung CancerJuan P Wisnivesky1*,1 Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY, USA; Division of Pulmonary, Critical Care Medicine and Sleep Medicine, Mount Sinai School of Medicine, New York, NY, USA, 2 Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY, USA, 3 Department of Radiology, New York-Presbytarian Hospital -Weill Cornell Medical Center, New York, NY, USA, 4 Department of Health Policy, Mount Sinai School of Medicine, New York, NY, USA, 5 Division of Pulmonary, Critical Care Medicine and Sleep Medicine, Mount Sinai School of Medicine, New York, NY, USA * To whom correspondence should be addressed. E-mail: juan.wisnivesky{at}mssm.edu.
Rationale: Important variations exist in the treatment of non-small-cell lung cancer. As resection is the most effective treatment for patients with early disease, disparities in surgical rates can generate considerable differences in outcomes. Objective: We analyzed data from a national population-based registry to evaluate disparities in the treatment of Hispanic and white patients with Stage I lung cancer and to assess the extent to which these inequalities explain survival differences. Methods: This study included 16,036 Hispanic and white patients with Stage I lung cancer diagnosed between 1991 and 2000. Cases were identified from the Surveillance, Epidemiology and End Results registry. Survival was compared among white and Hispanics using Kaplan Meier curves. Stratified survival curves and Cox regression were used to evaluate whether inequalities in stage (IA vs. IB) and resection could explain survival differences. Results: Hispanics had worse overall and lung-cancer specific survival compared to whites (p= 0.04 and 0.008, respectively). Five-year lung-cancer survival was 54% for Hispanics vs. 62% for whites. Hispanics were more frequently diagnosed with Stage IB (p=0.0002) and less likely to undergo resection (p=0.03). Among resected patients, survival was similar for the two groups, as it was among those unresected. After adjusting for surgery and stage there was no difference in survival between groups. Conclusions: Hispanics with Stage I lung cancer had worse survival as compared to whites. These disparities are largely explained by lower rates of resection and higher probability of diagnosis at Stage IB. Future work must delineate why Hispanics are receiving less surgery. Key words: lung cancer, treatment, disparities, ethnicity
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