Abstract
Introduction: In 2005, non‐small cell lung cancer (NSCLC) incidence and mortality rates in Alabama (77.5 per 100,000 population and 65.0, respectively) exceeded corresponding rates in the U.S. (67.7 and 52.8, respectively). Within Alabama, incidence and mortality vary by race, urban/rural residence, and other demographic characteristics. We examined racial (black versus white) and geographic (urban versus rural residence) differences in stage at diagnosis of NSCLC and treatment received (i.e., surgery, chemotherapy, radiation therapy) among Medicare beneficiaries in the state.
Methods: We linked Alabama State Cancer Registry data with Medicare claims to identify beneficiaries with NSCLC (either American Joint Committee on Cancer [AJCC] stages I–IV or unknown stage) diagnosed in 2000–2003. We examined distributions of NSCLC by race and geography, and applied multivariate logistic regression to compute odds of receiving stage‐specific treatment among beneficiaries.
Results: There were 3,929 beneficiaries with NSCLC: 86.7% were white, 13.3% black, 50% resided in the state's 55 rural counties, and 50% in the remaining12 urban counties. Blacks and whites in urban counties had slightly higher proportions of resectable NSCLC (stages I, II, IIIA) (36.2% and 47.2%, respectively) compared with blacks and whites in rural counties (31.2% and 44.2%, respectively). Proportions of unknown stage were higher among blacks and whites in rural counties (38.9% and 29.7%, respectively) compared with blacks and whites in urban counties (24.3% and 21.2%, respectively). Blacks had a 37% lower odds of undergoing surgery than whites (OR, 0.63; 95% confidence interval [CI] 0.41–0.96). This racial disparity was greater in rural counties, where the odds of blacks undergoing surgical resection were 52% lower than the odds for whites (OR, 0.48;CI 0.28–0.84). Among black beneficiaries who underwent surgery, those residing in urban counties had higher proportions of receipt of any adjuvant therapy (39.6%) than those in rural counties (19.2%). Among surgically‐treated whites, the receipt of any adjuvant therapy was similar in both types of counties (approximately 32%).
Conclusions: Disparities in receipt of treatment for NSCLC in Alabama exist. Future studies should focus on the reasons for these differences, which may be associated with access to health care in different counties, patients' knowledge of and beliefs about available treatment for their cancer, and physicians' attitudes toward treating patients with lung cancer.
Citation Information: Cancer Prev Res 2010;3(1 Suppl):A91.
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