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Farhood Farjah, MD, MPH; Douglas E. Wood, MD; N. David Yanez III, PhD; Thomas L. Vaughan, MD, MPH; Rebecca Gaston Symons, MPH; Bahirathan Krishnadasan, MD; David R. Flum, MD, MPH

Arch Surg. 2009;144(1):14-18.

Hypothesis  Health care system and provider biases and differences in patient characteristics are thought to be prevailing factors underlying racial disparities. The influence of these factors on the receipt of care would likely be mitigated among patients who are recommended optimal therapy. We hypothesized that there would be no significant evidence of racial disparities among patients with early-stage lung cancer who are recommended surgical therapy.

Design, Setting, and Patients  Retrospective cohort study of patients in the Surveillance, Epidemiology, and End Results–Medicare database who were diagnosed with stage I or II lung cancer between January 1, 1992, and December 31, 2002 (follow-up through December 31, 2005).

Main Outcome Measures  Receipt of lung resection and overall survival.

Results  Among 17 739 patients who were recommended surgical therapy (mean [SD] age, 75 [5] years; 89% white, 6% black), black patients less frequently underwent resection compared with white patients (69% vs 83%, respectively; P < .001). After adjustment, black race was associated with lower odds of receiving surgical therapy (odds ratio = 0.43; 99% confidence interval, 0.36-0.52). Unadjusted 5-year survival rates were lower for black patients compared with white patients (36% vs 42%, respectively; P < .001). After adjustment, there was no significant association between race and death (hazard ratio = 1.03; 99% confidence interval, 0.92-1.14) despite a 14% difference in receipt of optimal therapy.

Conclusions  Even among patients who were recommended surgical therapy, black patients underwent lung resection less often than white patients. Unexpectedly, racial differences in the receipt of optimal therapy did not appear to affect outcomes. These findings suggest that distrust, beliefs and perceptions about lung cancer and its treatment, and limited access to care (despite insurance) might have a more dominant role in perpetuating racial disparities than previously recognized.

Author Affiliations: Surgical Outcomes Research Center (Drs Farjah and Flum and Ms Symons) and Divisions of Cardiothoracic Surgery (Drs Wood and Krishnadasan) and General Surgery (Dr Flum), Department of Surgery, and Department of Biostatistics (Dr Yanez), University of Washington, and Department of Epidemiology, Fred Hutchinson Cancer Research Center (Dr Vaughan), Seattle; and Franciscan Health System, St Joseph Medical Center, Tacoma, Washington (Dr Krishandasan).

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