Background

Prior research demonstrated statistically significant racial disparities related to lung cancer treatment and outcomes. We examined differences in initial imaging and survival between Blacks, Hispanics and non-Hispanic Whites.

Methods

The linked Surveillance, Epidemiology, and End Results–Medicare database between 2007 and 2015 was used to compare initial imaging modality for patients with lung cancer. Participants included 28,881 non-Hispanic Whites, 3,123 Black, and 1,907 Hispanics, patients age ≥66 years who were enrolled in Medicare fee-for-service and diagnosed with lung cancer. The primary outcome was comparison of PET/CT utilization between groups. A secondary outcome was 12-month cancer specific survival. Information on stage, treatment, and treatment facility were included in the analysis. Chi-Square test and logistic regression were used to evaluate factors associated with imaging utilization. Kaplan-Meier method and Cox proportional hazards regression were used to calculate adjust hazard ratios and survival. All statistical tests were two-sided.

Results

After adjusting for demographic, community, and facility characteristics, Blacks were less likely to undergo PET/CT imaging at diagnosis compared to non-Hispanic Whites odds ratio (OR) 0.54; 95% CI 0.50, 0.59; P < 0.001). Hispanics were also less likely to receive PET/CT imaging (OR 0.72; 95% CI 0.65, 0.81 P < 0.001). PET/CT was associated with improved survival (HR = 0.61; 95% CI: 0.57, 0.65, P < 0.001).

Conclusion

Blacks and Hispanics are less likely to undergo guideline recommended PET/CT imaging at diagnosis of lung cancer, which may partially explain differences in survival. Awareness of this issue will allow for future interventions aimed at reducing this disparity.

中文翻译：

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PET/CT 在非小细胞肺癌诊断中的种族差异

背景

先前的研究表明，与肺癌治疗和结果相关的统计学上显着的种族差异。我们检查了黑人、西班牙裔和非西班牙裔白人在初始成像和生存方面的差异。

方法

2007 年至 2015 年期间链接的监测、流行病学和最终结果 - 医疗保险数据库用于比较肺癌患者的初始成像方式。参与者包括 28,881 名非西班牙裔白人、3,123 名黑人和 1,907 名西班牙裔患者，这些患者年龄≥66 岁，参加了按服务收费的医疗保险并被诊断患有肺癌。主要结果是比较各组之间的 PET/CT 利用率。次要结果是 12 个月的癌症特异性存活率。分析中包括阶段、治疗和治疗设施的信息。卡方检验和逻辑回归用于评估与成像利用相关的因素。Kaplan-Meier 方法和 Cox 比例风险回归用于计算调整风险比和生存率。所有统计测试都是双侧的。

结果

在根据人口统计学、社区和设施特征进行调整后，与非西班牙裔白人相比，黑人在诊断时接受 PET/CT 成像的可能性较小，比值比 (OR) 为 0.54；95% 置信区间 0.50, 0.59；P < 0.001）。西班牙裔美国人也不太可能接受 PET/CT 成像（OR 0.72；95% CI 0.65，0.81 P < 0.001）。PET/CT 与生存率提高相关（HR = 0.61；95% CI：0.57、0.65，P < 0.001）。

结论

黑人和西班牙裔不太可能在肺癌诊断时接受指南推荐的 PET/CT 成像，这可能部分解释了生存差异。意识到这个问题将有助于未来采取旨在减少这种差异的干预措施。