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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Veröffentlicht in:JNCI : Journal of the National Cancer Institute 2020-12, Vol.112 (12), p.1204-1212, Article 034
Hauptverfasser: Morgan, Rustain L, Karam, Sana D, Bradley, Cathy J
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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 
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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 &lt; .001). Hispanics were also less likely to receive PET with CT imaging (OR = 0.72, 95% CI = 0.65 to 0.81; P &lt; .001). PET with CT was associated with improved survival (HR = 0.61, 95% CI = 0.57 to 0.65; P &lt; .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>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,782,786,887,1586,27931,27932,28255</link.rule.ids><backlink>$$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 &lt; .001). Hispanics were also less likely to receive PET with CT imaging (OR = 0.72, 95% CI = 0.65 to 0.81; P &lt; .001). PET with CT was associated with improved survival (HR = 0.61, 95% CI = 0.57 to 0.65; P &lt; .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 &amp; numerical data</subject><subject>Early Detection of Cancer - classification</subject><subject>Early Detection of Cancer - methods</subject><subject>Early Detection of Cancer - statistics &amp; numerical data</subject><subject>Editor's Choice</subject><subject>Epidemiology</subject><subject>Ethnic factors</subject><subject>Ethnicity - statistics &amp; numerical data</subject><subject>Female</subject><subject>Government programs</subject><subject>Health Services Accessibility - statistics &amp; numerical data</subject><subject>Healthcare Disparities - ethnology</subject><subject>Hispanic people</subject><subject>Humans</subject><subject>Life Sciences &amp; 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 &amp; 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 &amp; 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 &amp; numerical data</topic><topic>Early Detection of Cancer - classification</topic><topic>Early Detection of Cancer - methods</topic><topic>Early Detection of Cancer - statistics &amp; numerical data</topic><topic>Editor's Choice</topic><topic>Epidemiology</topic><topic>Ethnic factors</topic><topic>Ethnicity - statistics &amp; numerical data</topic><topic>Female</topic><topic>Government programs</topic><topic>Health Services Accessibility - statistics &amp; numerical data</topic><topic>Healthcare Disparities - ethnology</topic><topic>Hispanic people</topic><topic>Humans</topic><topic>Life Sciences &amp; 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 &amp; 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 &amp; 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 &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; 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 &lt; .001). Hispanics were also less likely to receive PET with CT imaging (OR = 0.72, 95% CI = 0.65 to 0.81; P &lt; .001). PET with CT was associated with improved survival (HR = 0.61, 95% CI = 0.57 to 0.65; P &lt; .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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