Racial Disparities in Comorbidities Do Not Explain Lower NSCLC Surgery Rate Among Black Veterans

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(ChemotherapyAdvisor) – Black veterans in the United States diagnosed with early-stage non-small cell lung cancer (NSCLC) undergo surgery less frequently—and refuse surgery more often—than their white counterparts; however, racial differences in comorbidities “do not fully explain” this difference, results of a study reported in the Journal of Clinical Oncology published online on December 26, 2012.

“In an equal access health care system such as the Veterans Health Administration (VHA), we would expect minimal, if any, racial differences in lung cancer treatment and outcomes, but there is evidence of excess morbidity among blacks compared with whites,” reported lead author Christina D. Williams, PhD, of the Durham VA Medical Center, Durham, NC. “It is thus plausible that racial differences in comorbid conditions contribute to racial disparities observed in surgical resection.”

The investigators evaluated racial differences in the prevalence of comorbidity and their impact on receipt of surgery among 1,314 VHA patients—1,135 white, 179 black—diagnosed with early-stage NSCLC in 2007. Mean age was 68 years (67 years for blacks and 69 years for whites; P=0.041); 47.3% were married (38.5% blacks and 48.6% whites; P=0.013).

Hypertension, respiratory disease, diabetes mellitus, angina/coronary artery disease, and psychiatric disorder were the most prevalent individual comorbidities among both blacks and whites.

“Although the prevalence of most conditions was comparable among both races, the burden of several comorbidities was significantly different between blacks and whites,” Dr. Williams noted. “The most profound difference in prevalence was noted for respiratory disease, which was present in 28.5% of blacks and 48.4% of whites. Conversely, comorbidities more prevalent in blacks included hypertension, liver disease, renal disease, and illicit drug abuse.”

No racial difference were observed in overall comorbidity (P=0.747), but a higher proportion of blacks had poor performance status (13.4% vs 7.6%; P=0.010).

“Comorbidities alone do not explain the lower rates of surgical resection among blacks; therefore, reasons for undertreatment require further investigation to reduce this disparity in the quality of care,” they concluded.


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