30 year trends in racial disparities for early stage lung cancer treatment.

Abstract

1599 Background: Racial disparities in lung cancer treatment have been recognized for over 30 years. Our prior work showed that among Medicare beneficiaries diagnosed during 1992-2002, Black patients were less likely to receive curative therapy than White patients. As treatment approaches have evolved and increased attention has been paid to healthcare disparities, it is unclear whether this pattern has changed over time. We assessed temporal trends in racial disparities in receipt of curative therapy from 2005 to 2019, and compared findings to estimates from over 25 years earlier. Methods: Using the SEER-Medicare data linkage, we conducted a retrospective cohort study of Medicare fee for service beneficiaries diagnosed with stage I-II NSCLC during 3 time intervals: 2005-07, 2011-13, and 2017-19. Consistent with the prior study, we restricted the sample to Non-Latinx Black and Non-Latinx White patients. Curative therapy was defined as either surgery and/or radiation within 6 months of diagnosis. In our prior study, curative treatment was limited to surgery, as radiation was rarely used as curative therapy at that time. We performed multivariable logistic regression with receipt of any curative therapy as our outcome, controlling for sociodemographic and clinical covariates. We included a time*race interaction to evaluate whether receipt of treatment differed by race over time, and calculated the predicted probability of treatment across time and race group. Results: We identified 28,287 patients (7.5% Black) for study inclusion. Black and White patients were similar across most demographic variables; however, Black patients were more likely to have ≥3 comorbidities and to have been hospitalized in the year prior to diagnosis. Overall, receipt of curative therapy was lower among Black patients (69.9%) compared to White patients (83.3%) throughout the study period and across all time intervals (Table). In adjusted analyses, Black patients were less likely to receive curative treatment in all 3 time intervals, with a Black-White difference of -17.6% in 2005-07, -14.2% in 2011-13, and -9.7% in 2017-19 (p-value for time*race interaction = < 0.001). Compared to the 1992-94 and 2000-02 time intervals from the prior study where Black-White difference in receipt of treatment was -11.8% and -14.4% respectively, disparities have persisted. Conclusions: Racial disparities in receipt of curative treatment for early stage lung cancer in Medicare beneficiaries have persisted 30 years, with minimal improvement. Receipt of curative treatment by race and time period, adjusted. 1992-1994 a 2000–2002 a 2005-2007 b 2011-2013 b 2017-2019 b Black 73.1 64.9 66.2 (59.6, 72.7) 71.6 (65.8, 77.3) 77.7 (72.3, 83.1) White 84.9 79.3 83.8 (82.4, 85.1) 85.8 (84.4, 87.1) 87.4 (86.2, 88.6) Black:White Difference -11.8 -14.4 -17.6 (-24.3, -10.9) -14.2 (-20.1, -8.3) -9.7 (-15.2, -4.2) a Data from prior 2008 study. b Current Study.