Ethnic Disparities in Imaging Utilization at Diagnosis of Non-Small Cell Lung Cancer
Abstract 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 E...
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| creator | Morgan, Rustain L Karam, Sana D Bradley, Cathy J |
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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, 3123 black, and 1907 Hispanics, patients age 66 years and older who were enrolled in Medicare fee-for-service and diagnosed with lung cancer. The primary outcome was comparison of positron emission tomography (PET) imaging with computerized tomography (CT) imaging use between groups. A secondary outcome was 12-month cancer-specific survival. Information on stage, treatment, and treatment facility was included in the analysis. Chi-square test and logistic regression were used to evaluate factors associated with imaging use. Kaplan-Meier method and Cox proportional hazards regression were used to calculate adjusted 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 or CT imaging at diagnosis compared with non-Hispanic whites odds ratio (OR) = 0.54 (95% confidence interval [CI] = 0.50 to 0.59; P |
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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, 3123 black, and 1907 Hispanics, patients age 66 years and older who were enrolled in Medicare fee-for-service and diagnosed with lung cancer. The primary outcome was comparison of positron emission tomography (PET) imaging with computerized tomography (CT) imaging use between groups. A secondary outcome was 12-month cancer-specific survival. Information on stage, treatment, and treatment facility was included in the analysis. Chi-square test and logistic regression were used to evaluate factors associated with imaging use. Kaplan-Meier method and Cox proportional hazards regression were used to calculate adjusted 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 or CT imaging at diagnosis compared with non-Hispanic whites odds ratio (OR) = 0.54 (95% confidence interval [CI] = 0.50 to 0.59; P < .001). Hispanics were also less likely to receive PET with CT imaging (OR = 0.72, 95% CI = 0.65 to 0.81; P < .001). PET with CT was associated with improved survival (HR = 0.61, 95% CI = 0.57 to 0.65; P < .001).
Conclusions
Blacks and Hispanics are less likely to undergo guideline-recommended PET with 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.</description><identifier>ISSN: 0027-8874</identifier><identifier>EISSN: 1460-2105</identifier><identifier>DOI: 10.1093/jnci/djaa034</identifier><identifier>PMID: 32134453</identifier><language>eng</language><publisher>CARY: Oxford University Press</publisher><subject><![CDATA[Aged ; Aged, 80 and over ; Black people ; Carcinoma, Non-Small-Cell Lung - diagnosis ; Carcinoma, Non-Small-Cell Lung - ethnology ; Carcinoma, Non-Small-Cell Lung - mortality ; Chi-square test ; Computed tomography ; Confidence intervals ; Diagnosis ; Diagnostic Imaging - methods ; Diagnostic Imaging - statistics & numerical data ; Early Detection of Cancer - classification ; Early Detection of Cancer - methods ; Early Detection of Cancer - statistics & numerical data ; Editor's Choice ; Epidemiology ; Ethnic factors ; Ethnicity - statistics & numerical data ; Female ; Government programs ; Health Services Accessibility - statistics & numerical data ; Healthcare Disparities - ethnology ; Hispanic people ; Humans ; Life Sciences & Biomedicine ; Lung cancer ; Lung Neoplasms - diagnosis ; Lung Neoplasms - ethnology ; Lung Neoplasms - mortality ; Male ; Medical diagnosis ; Medical imaging ; Medicare ; Medicare - statistics & numerical data ; Non-small cell lung carcinoma ; Oncology ; Positron emission ; Positron emission tomography ; Race factors ; Regression analysis ; Science & Technology ; SEER Program ; Small cell lung carcinoma ; Statistical analysis ; Statistical tests ; Survival ; Survival Rate ; Tomography ; United States - epidemiology]]></subject><ispartof>JNCI : Journal of the National Cancer Institute, 2020-12, Vol.112 (12), p.1204-1212, Article 034</ispartof><rights>The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com 2020</rights><rights>The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.</rights><rights>The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>18</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000606177900006</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c406t-d62d23ae5a5b248ba32dc8e0ed76f012dbb119b84a146224decadf0ffcf4d2e33</citedby><cites>FETCH-LOGICAL-c406t-d62d23ae5a5b248ba32dc8e0ed76f012dbb119b84a146224decadf0ffcf4d2e33</cites><orcidid>0000-0002-3881-7257</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,781,785,886,1585,27929,27930,28253</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32134453$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Morgan, Rustain L</creatorcontrib><creatorcontrib>Karam, Sana D</creatorcontrib><creatorcontrib>Bradley, Cathy J</creatorcontrib><title>Ethnic Disparities in Imaging Utilization at Diagnosis of Non-Small Cell Lung Cancer</title><title>JNCI : Journal of the National Cancer Institute</title><addtitle>JNCI-J NATL CANCER I</addtitle><addtitle>J Natl Cancer Inst</addtitle><description>Abstract
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, 3123 black, and 1907 Hispanics, patients age 66 years and older who were enrolled in Medicare fee-for-service and diagnosed with lung cancer. The primary outcome was comparison of positron emission tomography (PET) imaging with computerized tomography (CT) imaging use between groups. A secondary outcome was 12-month cancer-specific survival. Information on stage, treatment, and treatment facility was included in the analysis. Chi-square test and logistic regression were used to evaluate factors associated with imaging use. Kaplan-Meier method and Cox proportional hazards regression were used to calculate adjusted 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 or CT imaging at diagnosis compared with non-Hispanic whites odds ratio (OR) = 0.54 (95% confidence interval [CI] = 0.50 to 0.59; P < .001). Hispanics were also less likely to receive PET with CT imaging (OR = 0.72, 95% CI = 0.65 to 0.81; P < .001). PET with CT was associated with improved survival (HR = 0.61, 95% CI = 0.57 to 0.65; P < .001).
Conclusions
Blacks and Hispanics are less likely to undergo guideline-recommended PET with 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.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Black people</subject><subject>Carcinoma, Non-Small-Cell Lung - diagnosis</subject><subject>Carcinoma, Non-Small-Cell Lung - ethnology</subject><subject>Carcinoma, Non-Small-Cell Lung - mortality</subject><subject>Chi-square test</subject><subject>Computed tomography</subject><subject>Confidence intervals</subject><subject>Diagnosis</subject><subject>Diagnostic Imaging - methods</subject><subject>Diagnostic Imaging - statistics & numerical data</subject><subject>Early Detection of Cancer - classification</subject><subject>Early Detection of Cancer - methods</subject><subject>Early Detection of Cancer - statistics & numerical data</subject><subject>Editor's Choice</subject><subject>Epidemiology</subject><subject>Ethnic factors</subject><subject>Ethnicity - statistics & numerical data</subject><subject>Female</subject><subject>Government programs</subject><subject>Health Services Accessibility - statistics & numerical data</subject><subject>Healthcare Disparities - ethnology</subject><subject>Hispanic people</subject><subject>Humans</subject><subject>Life Sciences & Biomedicine</subject><subject>Lung cancer</subject><subject>Lung Neoplasms - diagnosis</subject><subject>Lung Neoplasms - ethnology</subject><subject>Lung Neoplasms - mortality</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical imaging</subject><subject>Medicare</subject><subject>Medicare - statistics & numerical data</subject><subject>Non-small cell lung carcinoma</subject><subject>Oncology</subject><subject>Positron emission</subject><subject>Positron emission tomography</subject><subject>Race factors</subject><subject>Regression analysis</subject><subject>Science & Technology</subject><subject>SEER Program</subject><subject>Small cell lung carcinoma</subject><subject>Statistical analysis</subject><subject>Statistical tests</subject><subject>Survival</subject><subject>Survival Rate</subject><subject>Tomography</subject><subject>United States - epidemiology</subject><issn>0027-8874</issn><issn>1460-2105</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><sourceid>EIF</sourceid><recordid>eNqNkc1uEzEUhS0EoqGwY41GYsGCDvXfjCcbJDRtoVIEC8jauuOf1NHEDrYHRJ-GZ-HJ6jQhgg3CC3txv3vu8T0IPSf4DcFzdr72yp3rNQBm_AGaEd7imhLcPEQzjKmou07wE_QkpTUuZ075Y3TCKGGcN2yGlpf5xjtVXbi0heiyM6ly_tfP6w2snF9Vy-xGdwvZBV9BLhisfEguVcFWH4OvP29gHKvelGsxFb4Hr0x8ih5ZGJN5dnhP0fLq8kv_oV58en_dv1vUiuM217qlmjIwDTQD5d0AjGrVGWy0aC0mVA8DIfOh41B-RSnXRoG22FpluaaGsVP0dq-7nYaN0cr4HGGU2-g2EH_IAE7-XfHuRq7CNykEa4SgReDlQSCGr5NJWa7DFH3xLCkXLekaQttCne0pFUNK0djjBILlLgS5C0EeQij4iz9dHeHfWy_A6z3w3QzBJuVMWdoRKym1uCVCzHeB7aZ3_0_3Lt-H1YfJ59L6at8apu2_Pd8BjcS0cA</recordid><startdate>20201214</startdate><enddate>20201214</enddate><creator>Morgan, Rustain L</creator><creator>Karam, Sana D</creator><creator>Bradley, Cathy J</creator><general>Oxford University Press</general><general>Oxford Univ Press</general><general>Oxford Publishing Limited (England)</general><scope>AOWDO</scope><scope>BLEPL</scope><scope>DTL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TO</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-3881-7257</orcidid></search><sort><creationdate>20201214</creationdate><title>Ethnic Disparities in Imaging Utilization at Diagnosis of Non-Small Cell Lung Cancer</title><author>Morgan, Rustain L ; Karam, Sana D ; Bradley, Cathy J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c406t-d62d23ae5a5b248ba32dc8e0ed76f012dbb119b84a146224decadf0ffcf4d2e33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Black people</topic><topic>Carcinoma, Non-Small-Cell Lung - diagnosis</topic><topic>Carcinoma, Non-Small-Cell Lung - ethnology</topic><topic>Carcinoma, Non-Small-Cell Lung - mortality</topic><topic>Chi-square test</topic><topic>Computed tomography</topic><topic>Confidence intervals</topic><topic>Diagnosis</topic><topic>Diagnostic Imaging - methods</topic><topic>Diagnostic Imaging - statistics & numerical data</topic><topic>Early Detection of Cancer - classification</topic><topic>Early Detection of Cancer - methods</topic><topic>Early Detection of Cancer - statistics & numerical data</topic><topic>Editor's Choice</topic><topic>Epidemiology</topic><topic>Ethnic factors</topic><topic>Ethnicity - statistics & numerical data</topic><topic>Female</topic><topic>Government programs</topic><topic>Health Services Accessibility - statistics & numerical data</topic><topic>Healthcare Disparities - ethnology</topic><topic>Hispanic people</topic><topic>Humans</topic><topic>Life Sciences & Biomedicine</topic><topic>Lung cancer</topic><topic>Lung Neoplasms - diagnosis</topic><topic>Lung Neoplasms - ethnology</topic><topic>Lung Neoplasms - mortality</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Medical imaging</topic><topic>Medicare</topic><topic>Medicare - statistics & numerical data</topic><topic>Non-small cell lung carcinoma</topic><topic>Oncology</topic><topic>Positron emission</topic><topic>Positron emission tomography</topic><topic>Race factors</topic><topic>Regression analysis</topic><topic>Science & Technology</topic><topic>SEER Program</topic><topic>Small cell lung carcinoma</topic><topic>Statistical analysis</topic><topic>Statistical tests</topic><topic>Survival</topic><topic>Survival Rate</topic><topic>Tomography</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Morgan, Rustain L</creatorcontrib><creatorcontrib>Karam, Sana D</creatorcontrib><creatorcontrib>Bradley, Cathy J</creatorcontrib><collection>Web of Science - Science Citation Index Expanded - 2020</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JNCI : Journal of the National Cancer Institute</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Morgan, Rustain L</au><au>Karam, Sana D</au><au>Bradley, Cathy J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ethnic Disparities in Imaging Utilization at Diagnosis of Non-Small Cell Lung Cancer</atitle><jtitle>JNCI : Journal of the National Cancer Institute</jtitle><stitle>JNCI-J NATL CANCER I</stitle><addtitle>J Natl Cancer Inst</addtitle><date>2020-12-14</date><risdate>2020</risdate><volume>112</volume><issue>12</issue><spage>1204</spage><epage>1212</epage><pages>1204-1212</pages><artnum>034</artnum><issn>0027-8874</issn><eissn>1460-2105</eissn><abstract>Abstract
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, 3123 black, and 1907 Hispanics, patients age 66 years and older who were enrolled in Medicare fee-for-service and diagnosed with lung cancer. The primary outcome was comparison of positron emission tomography (PET) imaging with computerized tomography (CT) imaging use between groups. A secondary outcome was 12-month cancer-specific survival. Information on stage, treatment, and treatment facility was included in the analysis. Chi-square test and logistic regression were used to evaluate factors associated with imaging use. Kaplan-Meier method and Cox proportional hazards regression were used to calculate adjusted 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 or CT imaging at diagnosis compared with non-Hispanic whites odds ratio (OR) = 0.54 (95% confidence interval [CI] = 0.50 to 0.59; P < .001). Hispanics were also less likely to receive PET with CT imaging (OR = 0.72, 95% CI = 0.65 to 0.81; P < .001). PET with CT was associated with improved survival (HR = 0.61, 95% CI = 0.57 to 0.65; P < .001).
Conclusions
Blacks and Hispanics are less likely to undergo guideline-recommended PET with 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.</abstract><cop>CARY</cop><pub>Oxford University Press</pub><pmid>32134453</pmid><doi>10.1093/jnci/djaa034</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-3881-7257</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Black people Carcinoma, Non-Small-Cell Lung - diagnosis Carcinoma, Non-Small-Cell Lung - ethnology Carcinoma, Non-Small-Cell Lung - mortality Chi-square test Computed tomography Confidence intervals Diagnosis Diagnostic Imaging - methods Diagnostic Imaging - statistics & numerical data Early Detection of Cancer - classification Early Detection of Cancer - methods Early Detection of Cancer - statistics & numerical data Editor's Choice Epidemiology Ethnic factors Ethnicity - statistics & numerical data Female Government programs Health Services Accessibility - statistics & numerical data Healthcare Disparities - ethnology Hispanic people Humans Life Sciences & Biomedicine Lung cancer Lung Neoplasms - diagnosis Lung Neoplasms - ethnology Lung Neoplasms - mortality Male Medical diagnosis Medical imaging Medicare Medicare - statistics & numerical data Non-small cell lung carcinoma Oncology Positron emission Positron emission tomography Race factors Regression analysis Science & Technology SEER Program Small cell lung carcinoma Statistical analysis Statistical tests Survival Survival Rate Tomography United States - epidemiology |
| title | Ethnic Disparities in Imaging Utilization at Diagnosis of Non-Small Cell Lung Cancer |
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