By Andrew M. Seaman
NEW YORK (Reuters Health) - Black lung cancer patients seem more likely to die of the disease than white cancer patients in the U.S., especially those living in segregated counties, according to a new study.
Researchers, who published their findings in JAMA Surgery on Wednesday, found blacks patients living in segregated counties had a lung cancer mortality rate about 10 percentage points higher than those living in diverse neighborhoods during the mid-2000s.
That compared to white lung cancer patients whose lung cancer mortality rate did not seem to change between segregated and diverse areas.
"We first thought it was a mistake. We ran it five times through the program," said the study's lead author Dr. Awori Hayanga, a lung transplant fellow at the University of Pittsburgh Medical Center.
"If you are one color living in one type of neighborhood versus another, 10 percent is huge," he said.
According to the American Cancer Society, lung cancer is the leading cause of cancer deaths for both men and women. It kills more people than colon, breast and prostate cancer combined.
In 2013, the Society projects over 228,000 Americans will be diagnosed with lung cancer, and about 159,500 will die from it.
For the new study, Hayanga and his colleagues used national databases to collect information on lung cancer deaths in U.S. counties between 2003 and 2007. They also classified those counties as low, moderate and high segregated areas based on their concentration of one race versus another.
Nationally, black lung cancer patients had about a 59 percent mortality rate when the researchers accounted for smoking and income, compared to about a 52 percent mortality rate in white patients.
When looking at specific counties, the researchers found white lung cancer patients' mortality rate remained steady between diverse and predominantly white counties - between about 50 percent and 53 percent.
For black lung cancer patients, however, there were larger differences.
Black patients living in diverse counties had a mortality rate of about 52 percent, which was comparable to white patients.
But black patients living in highly segregated counties had a mortality rate of about 63 percent. Black patients living in moderately segregated areas had a mortality rate of 57 percent.
While the study cannot prove living in a segregated community caused the worse mortality rates in black patients, Hayanga said there is probably something different in predominantly black communities.
ENVIRONMENTAL VS. PATIENT FACTORS
"The point I'm trying to make is that neighborhood segregation is not just a proxy for socioeconomic status. We accounted for that," said Hayanga. "That's where we ask ourselves, do we know about the different fabric of different neighborhoods?"
He told Reuters Health that by comparing different counties, a person would find one has resources the other does not, such as hospitals and doctors.
The new study shows there are some health problems that can't be explained by genetics and treated with drugs, said David Chang, who wrote a commentary accompanying the work.
Disparities are "probably one of the issues that it's not the patients that matter but the systems," Chang, from the University of California, San Diego, told Reuters Health.
"Location matters, and one has to be critical about where they live and where they pay taxes," said Hayanga, who worked with Chang on previous research.
Dr. Karen Reckamp, a lung cancer specialist at City of Hope in Duarte, California, said there should be a focus on getting cancer care where it's needed.
"There is more technology in our healthcare and it's becoming more complex. People living in more remote areas wouldn't have the knowledge or access to seek out that care," said Reckamp, who was not involved with the new study.
She added that the new research doesn't answer what needs to change in those communities, but may shine a light on where the disparities are coming from.
"What we're seeing is that we can't uproot half of the American population and move them to other counties. What we have to do is take responsibility for those neighborhoods," said Hayanga.
SOURCE: http://bit.ly/YbHRkk JAMA Surgery, online January 16, 2013.