Racial disparities and survival for nonsmall-cell lung cancer in a large cohort of black and white elderly patients

Dale Sharon Hardy, Rui Xia, Chih Chin Liu, Janice N. Cormier, Zhannat Nurgalieva, Xianglin L. Du

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Abstract

BACKGROUND: This study aimed to examine disparities in survival and associated factors for patients with nonsmall-cell lung cancer (NSCLC) and to determine whether racial disparities varied over time (1991-1995, 1996-1999, and 2000-2002). METHODS: The authors studied 70,901 patients aged ≥65 years with stage I-IV NSCLC identified from Surveillance, Epidemiology, and End Results/Medicare data. Multivariate time-to-event survival analyses were completed using Cox proportional regression modeling. RESULTS: The 5-year observed lung cancer-specific survival rates were 52.7% for whites and 47.5% for blacks with stage I-II disease, and 17.7% and 19.6% for whites and blacks, respectively at stages III-IV. After controlling for standard treatment, socioeconomic status (SES), and other factors, there were no significant differences in all-cause mortality, or lung cancer-specific mortality between black and white patients with stage I-II or III-IV lung cancer. However, blacks had an increased risk for overall all-cause mortality at stage I-IV (hazard ratio [HR], 1.24; 95% confidence interval, 1.13-1.35), and during 2000-2002 at stage III-IV for all-cause mortality (HR, 1.22; 95% CI, 1.02-1.47) and lung cancer-specific mortality (HR, 1.24; 95% CI,1.01-1.53). Standard treatment was significantly associated with increased survival, whereas poor SES was associated with increased mortality. CONCLUSIONS: There were no significant differences in survival between blacks and whites with NSCLC within stage stratifications after adjusting for covariates, except for black patients at overall stage for all-cause mortality and at stage III-IV diagnosed in 2000-2002. Receiving stage-specific evidence-based standard therapy was associated with significantly increased survival.

Original languageEnglish (US)
Pages (from-to)4807-4818
Number of pages12
JournalCancer
Volume115
Issue number20
DOIs
StatePublished - Oct 15 2009

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Non-Small Cell Lung Carcinoma
Survival
Mortality
Lung Neoplasms
Social Class
Survival Analysis
Medicare
hydroquinone
Epidemiology
Therapeutics
Survival Rate
Confidence Intervals

Keywords

  • Health disparity
  • Nonsmall-cell lung cancer
  • Race/ethnicity
  • Standard treatment
  • Survival
  • Survival rates

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Hardy, D. S., Xia, R., Liu, C. C., Cormier, J. N., Nurgalieva, Z., & Du, X. L. (2009). Racial disparities and survival for nonsmall-cell lung cancer in a large cohort of black and white elderly patients. Cancer, 115(20), 4807-4818. https://doi.org/10.1002/cncr.24521

Racial disparities and survival for nonsmall-cell lung cancer in a large cohort of black and white elderly patients. / Hardy, Dale Sharon; Xia, Rui; Liu, Chih Chin; Cormier, Janice N.; Nurgalieva, Zhannat; Du, Xianglin L.

In: Cancer, Vol. 115, No. 20, 15.10.2009, p. 4807-4818.

Research output: Contribution to journalArticle

Hardy, DS, Xia, R, Liu, CC, Cormier, JN, Nurgalieva, Z & Du, XL 2009, 'Racial disparities and survival for nonsmall-cell lung cancer in a large cohort of black and white elderly patients', Cancer, vol. 115, no. 20, pp. 4807-4818. https://doi.org/10.1002/cncr.24521
Hardy, Dale Sharon ; Xia, Rui ; Liu, Chih Chin ; Cormier, Janice N. ; Nurgalieva, Zhannat ; Du, Xianglin L. / Racial disparities and survival for nonsmall-cell lung cancer in a large cohort of black and white elderly patients. In: Cancer. 2009 ; Vol. 115, No. 20. pp. 4807-4818.
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abstract = "BACKGROUND: This study aimed to examine disparities in survival and associated factors for patients with nonsmall-cell lung cancer (NSCLC) and to determine whether racial disparities varied over time (1991-1995, 1996-1999, and 2000-2002). METHODS: The authors studied 70,901 patients aged ≥65 years with stage I-IV NSCLC identified from Surveillance, Epidemiology, and End Results/Medicare data. Multivariate time-to-event survival analyses were completed using Cox proportional regression modeling. RESULTS: The 5-year observed lung cancer-specific survival rates were 52.7{\%} for whites and 47.5{\%} for blacks with stage I-II disease, and 17.7{\%} and 19.6{\%} for whites and blacks, respectively at stages III-IV. After controlling for standard treatment, socioeconomic status (SES), and other factors, there were no significant differences in all-cause mortality, or lung cancer-specific mortality between black and white patients with stage I-II or III-IV lung cancer. However, blacks had an increased risk for overall all-cause mortality at stage I-IV (hazard ratio [HR], 1.24; 95{\%} confidence interval, 1.13-1.35), and during 2000-2002 at stage III-IV for all-cause mortality (HR, 1.22; 95{\%} CI, 1.02-1.47) and lung cancer-specific mortality (HR, 1.24; 95{\%} CI,1.01-1.53). Standard treatment was significantly associated with increased survival, whereas poor SES was associated with increased mortality. CONCLUSIONS: There were no significant differences in survival between blacks and whites with NSCLC within stage stratifications after adjusting for covariates, except for black patients at overall stage for all-cause mortality and at stage III-IV diagnosed in 2000-2002. Receiving stage-specific evidence-based standard therapy was associated with significantly increased survival.",
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AU - Hardy, Dale Sharon

AU - Xia, Rui

AU - Liu, Chih Chin

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AU - Nurgalieva, Zhannat

AU - Du, Xianglin L.

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N2 - BACKGROUND: This study aimed to examine disparities in survival and associated factors for patients with nonsmall-cell lung cancer (NSCLC) and to determine whether racial disparities varied over time (1991-1995, 1996-1999, and 2000-2002). METHODS: The authors studied 70,901 patients aged ≥65 years with stage I-IV NSCLC identified from Surveillance, Epidemiology, and End Results/Medicare data. Multivariate time-to-event survival analyses were completed using Cox proportional regression modeling. RESULTS: The 5-year observed lung cancer-specific survival rates were 52.7% for whites and 47.5% for blacks with stage I-II disease, and 17.7% and 19.6% for whites and blacks, respectively at stages III-IV. After controlling for standard treatment, socioeconomic status (SES), and other factors, there were no significant differences in all-cause mortality, or lung cancer-specific mortality between black and white patients with stage I-II or III-IV lung cancer. However, blacks had an increased risk for overall all-cause mortality at stage I-IV (hazard ratio [HR], 1.24; 95% confidence interval, 1.13-1.35), and during 2000-2002 at stage III-IV for all-cause mortality (HR, 1.22; 95% CI, 1.02-1.47) and lung cancer-specific mortality (HR, 1.24; 95% CI,1.01-1.53). Standard treatment was significantly associated with increased survival, whereas poor SES was associated with increased mortality. CONCLUSIONS: There were no significant differences in survival between blacks and whites with NSCLC within stage stratifications after adjusting for covariates, except for black patients at overall stage for all-cause mortality and at stage III-IV diagnosed in 2000-2002. Receiving stage-specific evidence-based standard therapy was associated with significantly increased survival.

AB - BACKGROUND: This study aimed to examine disparities in survival and associated factors for patients with nonsmall-cell lung cancer (NSCLC) and to determine whether racial disparities varied over time (1991-1995, 1996-1999, and 2000-2002). METHODS: The authors studied 70,901 patients aged ≥65 years with stage I-IV NSCLC identified from Surveillance, Epidemiology, and End Results/Medicare data. Multivariate time-to-event survival analyses were completed using Cox proportional regression modeling. RESULTS: The 5-year observed lung cancer-specific survival rates were 52.7% for whites and 47.5% for blacks with stage I-II disease, and 17.7% and 19.6% for whites and blacks, respectively at stages III-IV. After controlling for standard treatment, socioeconomic status (SES), and other factors, there were no significant differences in all-cause mortality, or lung cancer-specific mortality between black and white patients with stage I-II or III-IV lung cancer. However, blacks had an increased risk for overall all-cause mortality at stage I-IV (hazard ratio [HR], 1.24; 95% confidence interval, 1.13-1.35), and during 2000-2002 at stage III-IV for all-cause mortality (HR, 1.22; 95% CI, 1.02-1.47) and lung cancer-specific mortality (HR, 1.24; 95% CI,1.01-1.53). Standard treatment was significantly associated with increased survival, whereas poor SES was associated with increased mortality. CONCLUSIONS: There were no significant differences in survival between blacks and whites with NSCLC within stage stratifications after adjusting for covariates, except for black patients at overall stage for all-cause mortality and at stage III-IV diagnosed in 2000-2002. Receiving stage-specific evidence-based standard therapy was associated with significantly increased survival.

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