The Journal of Thoracic and Cardiovascular Surgery
Thoracic: Lung CancerDisparities in early-stage lung cancer outcomes at minority-serving hospitals compared with nonminority serving hospitals
Graphical abstract
Section snippets
Study Design and Population
This was a retrospective cohort study using data from the National Cancer Data Base (NCDB) (http://ncdbpuf.facs.org/). Patients diagnosed with clinical stage I non–small cell lung cancer (NSCLC) between 2008 and 2016 were included. Demographic data obtained included age, sex, race/ethnicity, geographic location, insurance type, and median income. Median income was derived from American Community Survey data and patient zip code. Clinicopathologic data evaluated included variables such as tumor
Demographic and Clinicopathologic Data
A total of 142,580 patients with clinical stage I NSCLC were identified from 1192 hospitals. There were 120 hospitals categorized as MSHs, whereas 1072 were classified as non-MSHs. The most common age group was 71 to 80 years (n = 47,740 [33%]). The majority of patients were non-Hispanic White (NHW) (n = 121,240 [85%]) followed by African American (n = 12,772 [9%]), Hispanic (n = 3749 [3%]), and Asian (n = 3023 [2%]). Most patients obtained care at non-MSHs (n = 132,089 [92.6%]), whereas 7.4%
Discussion
Surgical resection continues to be the mainstay of therapy for patients with operable early-stage NSCLC. In this study, we found that MSHs performed surgery in this population significantly less often than non-MSHs. However, when surgery was performed, the quality of surgical and oncologic care, as well as OS, was similar between MSHs and non-MSHs. Additionally, regardless of hospital type, African American patients were less likely to undergo definitive resection compared with their NHW
Conclusions
Patients with stage I NSCLC treated at MSHs underwent resection significantly less often compared with those cared for at non-MSHs. When surgical care was obtained at MSHs, it appears to be of similar oncologic and surgical quality compared with non-MSHs, despite diminished resources and funding.4,32 Qualitative work may further inform the reasons underlying disparities in surgical utilization between these hospital types.
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Supported by contributions from the Mason Family Research Fund.
Internal Review Board Approval No.: 2021 to 0752 (approved August 24, 2021).