UMMS Affiliation

Department of Radiation Oncology; Department of Radiology; Department of Medical Oncology; Department of Surgery, Division of Thoracic Surgery; Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine; Department of Orthopedics and Rehabilitation; Department of Quantitative Health Sciences

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Clinical Epidemiology | Demography, Population, and Ecology | Epidemiology | Medicine and Health | Neoplasms | Race and Ethnicity | Respiratory Tract Diseases


To investigate the interrelation between economic, marital, and known histopathologic/therapeutic prognostic factors in presentation and survival of patients with lung cancer in nine different ethnic groups. A retrospective review of the SEER database was conducted through the years 2007-2012. Population differences were assessed via chi-square testing. Multivariable analyses (MVA) were used to detect overall survival (OS) differences in the total population (TP, N = 153,027) and for those patients presenting with Stage IV (N = 70,968). Compared to Whites, Blacks were more likely to present with younger age, male sex, lower income, no insurance, single/widowed partnership, less squamous cell carcinomas, and advanced stage; and experience less definitive surgery, lower OS, and lung cancer-specific (LCSS) survival. White Hispanics presented with younger age, higher income, lower rates of insurance, single/widowed partnership status, advanced stage, more adenocarcinomas, and lower rates of definitive surgery, but no difference in OS and LCSS than Whites. In the TP and Stage IV populations, MVAs revealed that OS was better or equivalent to Whites for all other ethnic groups and was positively associated with insurance, marriage, and higher income. Blacks presented with more advanced disease and were more likely to succumb to lung cancer, but when adjusted for prognostic factors, they had a better OS in the TP compared to Whites. Disparities in income, marital status, and insurance rather than race affect OS of patients with lung cancer. Because of their presentation with advanced disease, Black and Hispanics are likely to have increased benefit from lung cancer screening.


Disparities, insurance, lung cancer, marriage, metastatic lung cancer, outcomes, race, socio-economic factors

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© 2018 The Authors. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

DOI of Published Version



Cancer Med. 2018 Apr;7(4):1211-1220. doi: 10.1002/cam4.1430. Epub 2018 Mar 13. Link to article on publisher's site

Journal/Book/Conference Title

Cancer medicine

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Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.