Segregation linked to mortality in black lung cancer patients

January 17, 2013 | by Shawn Le

Lung cancer is a tough disease to treat. Only 18 percent of patients diagnosed with nonsmall cell lung cancer are alive five years after their diagnosis, and only 6 percent of small cell lung cancer patients are alive five years after their diagnosis.

Researchers knew that African-American patients have a higher death rate from lung cancer than white patients. Now they've found that, depending on black patients' neighborhoods, those numbers may be even worse than expected.

 

Distribution of black population by county Black population of the U.S. based on 2010 Census data is shown in this map. (Image credit: www.census.gov)

 

On Wednesday, the journal JAMA Surgery published a study by University of Washington researchers who wanted “to examine the relationship between race and lung cancer mortality and the effect of residential segregation in the United States.”

The study found that the lung cancer death rate for black patients rises with the neighborhood’s percentage of African-American residents. On the other hand, segregation was linked in an opposite way to white patients’ death rate. For them, the death rate decreases as the percentage of white residents rises.

As the study found: "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."

Wrote the researchers: “Blacks have comparatively poorer access to specialty physicians, which exacerbates their race specific cancer profile and allows the outcomes gap between whites and blacks to continue to widen.”

The study's lead author Dr. Awori Hayanga, a lung transplant fellow at the University of Pittsburgh Medical Center, told Reuters:

"The point I'm trying to make is that neighborhood segregation is not just a proxy for socioeconomic status. We accounted for that," said Hayanga. "That's where we ask ourselves, do we know about the different fabric of different neighborhoods?"

City of Hope lung cancer specialist Karen Reckamp, M.D., M.S., sees access to health care as a key factor in the study’s results. She said that, unfortunately, health disparities along racial lines have also been demonstrated in cardiovascular disease and other illnesses.

“Heath-care disparities based on race are a longstanding problem in the United States attributed to a variety of causes with the end result of increased lung cancer mortality in blacks over whites,” said Reckamp, who was not involved with the study. “More questions remain, but this work helps to initiate a dialogue as we aim to improve health care for all Americans.”

Cancer research, overall, has revealed the genetic foundations of many cancers, but studies of lung cancer have been more difficult to characterize. Reckamp said that no primary lung cancer gene has been identified across most patients, but different racial groups have different active genes.

“We know that patients with Asian ethnicity more frequently develop lung cancers associated with genetic changes, although research within Hispanic and black populations is limited,” she said.

For Reckamp, the take-home message people of the study is the need to discuss “current access to care and patterns leading to ongoing segregation in communities.”  She said that patients and physicians need to build a relationship based on trust, so that all questions can be asked and all options can be put on the table for consideration.

The study focused on black and white Americans, using public health data on lung cancer deaths from 2003 to 2007. It also relied on population data from 2009 that provided the demographic makeup of the country by counties.

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