Underuse of Surgical Resection for Localized, Non–Small Cell Lung Cancer Among Whites and African Americans in South Carolina

Background Early studies using Medicare data reported racial disparities in surgical treatment of localized, non–small cell lung cancer. We analyzed the independent effect of race on use of surgical resection in a recent, population-based sample of patients with localized non–small cell lung cancer, controlling for comorbidity and socioeconomic status. Methods All cases of localized non–small cell lung cancer reported to our state Cancer Registry between 1996 and 2002 were identified and linked to the Inpatient/Outpatient Surgery Files and 2000 Census. Comorbidity (Romano-Charlson index) was calculated using administrative data codes. Educational level and income were estimated using census data. Characteristics of white and African American patients were compared using χ2 tests. Odds ratios of resection and 95% confidence intervals were calculated using logistic regression. Results We identified 2,506 white and 550 African American patients. African Americans were more likely to be younger, male, not married, less educated, poor, and uninsured or covered by Medicaid (all p < 0.0001), and to reside in rural communities (p = 0.0005). Use of surgical resection across races was lower than previously reported, and African Americans were significantly less likely to undergo surgery compared with whites (44.7% versus 63.4%; p < 0.0001). Even after controlling for sociodemographics, comorbidity, and tumor factors, the adjusted odds ratio for resection for African Americans was 0.43 (95% confidence interval, 0.34 to 0.55). Conclusions Underuse of surgical resection for localized, non–small cell lung cancer is a persistent problem, particularly among African Americans. Further studies are urgently needed to identify the patient-, physician-, and health system–related factors underlying these observations and optimize resection rates for non–small cell lung cancer.