Racial Disparities in Overall Survival and Surgical Treatment for Early Stage Lung Cancer by Facility Type

Abstract Background Early stage Non-small cell lung cancer (NSCLC) is potentially curable with surgical resection. There are persistent racial disparities for the receipt of surgery and overall survival rate for early stage NSCLC. The facility type where patients receive NSCLC treatment may directly impact racial disparities. Black patients who receive their treatment at academic facilities had a higher rate of surgery and higher overall survival compared to black patients treated at community facility types. Methods A total of 111,009 patients with the American Joint Committee on Cancer (AJCC) TNM clinical stage I and II NSCLC that were reported to the National Cancer Data Base (NCDB) were analyzed. Healthcare facilities were dichotomized into the community and academic facility types. A multivariate adjusted multinomial logistic regression was used to evaluate differences in the probability of undergoing surgery based on race and facility type. Kaplan Meier 3 and 5-year overall survival estimates were calculated for black and white patients based on treatment and the facility type where patients received care. Results We identified 99,767 white (89.87%) and 11,242 (10.12%) black patients with early stage NSCLC. Black patients were more likely to undergo surgery at academic facilities (OR: 1.12; 95% CI: 1.01 – 1.24; p-value = 0.04) compared to community facilities. Black patients treated at academic facility types demonstrated significantly better 3 and 5-year overall survival compared to black patients treated at community facilities (Log Rank p-value Conclusion Black patients with early stage NSCLC who were treated at academic facility types had a significantly higher overall survival compared black patients treated at community facility types. The odds of black patients undergoing surgery were higher at academic facilities compared to community facilities.