(ChemotherapyAdvisor) – Regardless of socioeconomic status, lung cancer mortality is higher in blacks, and highest in blacks living in the most segregated counties of the United States, a retrospective study concluded in the January issue of JAMA Surgery, a JAMA Network publication, online January 16, 2013.
Using data from the 2009 Area Resource File and Surveillance Epidemiology and End Results program, Awori J. Hayanga, MD, MPH, of the University of Washington, Seattle, and colleagues examined the relationship between race and lung cancer mortality and the effect of residential segregation from 2003 to 2007.
The investigators found the lung cancer mortality rate overall was 58.9% per 100,000 population for blacks compared with 52.4% per 100,000 population for whites.
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Segregation was highest in the Northeast, Midwest, and South and lowest in the Northwest. Of the US population, 28% live in counties with low segregation, 40% with moderate segregation, and 32% with high segregation.
“Blacks living in counties with the highest levels of segregation had a 10% higher mortality rate than those residing in counties with the lowest level of segregation,” Dr. Hayanga noted. “This increase was not observed among the white population, and, in contradistinction, the mortality rate was 3% lower among whites living in the most segregated counties when compared with those living in the least segregated counties. These findings persisted even after accounting for smoking prevalence and socioeconomic status, challenging the construct that segregation served as a proxy for socioeconomic status.”
Each additional level of segregation was associated with a 0.5% increase in lung cancer mortality for blacks (P<0.001) and an associated decrease in mortality for whites (P=0.002).
Among counties with the least segregation (<40%), the adjusted lung cancer mortality rate among blacks was 52.4% per 100,000 compared with 62.9% per 100,000 population in counties with the highest levels of segregation (≥60% segregation).
“The equalization of lung cancer mortality rates between the black and white races might require that counties, or census tracts, of high segregation, with their attendant physical deprivation, social ills, and limited access, receive more attention to address the existing disparities,” the authors conclude. “Public health initiatives, such as smoking cessation and early cancer screening programs, should be prioritized in these counties. Access to screening and expedient referral to specialist care should be optimized to ensure that the benefits of early cancer screening are realized.”
The authors noted that because they performed a cross-sectional analysis, they were unable to make causal inferences at the individual level. In addition, the investigators were only able to calculate mortality rates for blacks for 33.8% of the US counties due to small sample sizes.
