FROM CANCER EPIDEMIOLOGY, BIOMARKERS & PREVENTION
The demographic characteristics of neighborhoods are associated with the odds of receiving surgical treatment for early non–small-cell lung cancer (NSCLC), according to a study published in Cancer Epidemiology, Biomarkers & Prevention.
Living in areas with higher economic deprivation was associated with lower odds of receiving surgery for both black and white patients, in a retrospective study of 8,322 patients with early-stage NSCLC.
“The results of this study are intended to bring importance to segregation and other characteristics as determinants of lung cancer outcomes. As a result, what is learned from these epidemiologic findings can be applied to interventions and public policies to improve patient outcomes and contribute to the difficult and complex task of reducing racial health disparities,” wrote Dr. Asal M. Johnson of Stetson University and her associates ( Cancer Epidemiol Biomarkers Prev; 25[5];750-8 ).
The early-stage NSCLC patients were identified in the Georgia Comprehensive Cancer Registry from 2000 to 2009 to determine the effects of residential segregation and other neighborhood characteristics on the odds of receiving surgical treatment and the risk of death based on 5-year survival.
Three separate multilevel models were employed: A, economic deprivation; B, segregation; and C, segregation and economic deprivation. Individual-level variables (age, sex, and tumor grade) and area-level variables (place of residence, educational attainment, and elderly concentration) were controlled for in all models.
Regarding odds of surgical intervention, model A showed that living in areas with higher economic deprivation was associated with lower odds of receiving surgery for both black and white patients. Model B demonstrated that living in highly segregated areas was associated with lower odds of receiving surgery among black patients only. For white patients, no significant associations were observed between living in areas with combined segregation-deprivation and receipt of surgery using model C; however, living in segregated areas, regardless of the level of economic deprivation, was associated with decreased odds of receiving surgery for black patients.
As for 5-year survival, all three models indicated no effects of economic deprivation, segregation, or the combination of segregation and deprivation on survival among white patients. Models A and B showed no effects of economic deprivation or segregation on survival in black patients. In model C, however, the combination of high residential segregation and high economic deprivation was associated with a 31% higher risk of death in these patients, even after surgery.
Funding was provided by Stetson University. The authors reported no conflicts of interest.
