Racial disparities in occupational risks and lung cancer incidence: Analysis of the National Lung Screening Trial

The relationship between racial disparities in occupational risk and lung cancer diagnosis is not well defined. We examined occupational exposure to asbestos, silica, and other workplace chemicals, fumes, or dusts as reported in the National Lung Screening Trial (NLST). Descriptive analyses and multivariate logistic regression models were performed. Among the NLST study cohort, 3.9% were diagnosed with lung cancer. African-Americans had a higher rate of lung cancer diagnosis than White individuals (4.3% vs. 3.9%). About 28% reported at least one occupational exposure, including 6.5% exposed to silica and 4.7% to asbestos. African-Americans reported occupational exposure more frequently than White participants, including exposures to asbestos and silica. In a multivariate model, the interactions of all measures of occupational exposures and smoking status were significant. Current smokers with occupational exposures had higher odds of lung cancer diagnosis (aOR = 2.01, 95% CI = 1.76–2.30 for any exposure as well as higher odds after silica (aOR = 2.35, 95% CI = 1.89–2.91) or asbestos (aOR = 1.97, 95% CI = 1.52–2.56) exposure compared to former smokers without any exposures. African-Americans had higher odds of lung cancer diagnosis than White individuals (aOR = 1.24 to 1.25, 95% CI = 1.01–1.54). Our findings indicate that we need more effective public health prevention programs, especially for minorities who may have disproportionately greater occupational exposures due to socioeconomic constructs and barriers. Interventions may include education about occupational risks and lung cancer screening or instituting workplace policies for smoke-free environments with tobacco cessation support. •The NLST data showed racial disparities of lung cancer development.•African-Americans reported higher occupational exposures than Whites.•Occupational exposure and smoking had a multiplicative effect on lung cancer development.