Study connects local wealth and education to lung cancer detection

Lung cancer is the largest cause of cancer fatalities in the United States, and early identification and treatment are critical to patient survival. Wiley discovered that education and income in the neighbourhood were associated to the stage of patients’ lung cancer at the time of diagnosis in a recent research published online in CANCER, a peer-reviewed publication of the American Cancer Society.

According to research, individuals with lower income and education levels, as well as those living in more socioeconomically underserved areas, have a disproportionately low chance of surviving lung cancer. In the United States, racial/ethnic minorities had a higher prevalence of lung cancer-related death.

A team led by Tomi F. Akinyemiju, PhD, MS, of Duke University School of Medicine examined data from the 2004-2016 National Cancer Database of US patients aged 18-89 years old who were diagnosed with any stage of non-small cell lung cancer.

The researchers also gathered data on the education and income levels of the locations where patients lived, as well as information on patients’ health insurance status and where they got care.

Among the 1,329,972 patients in the research, 17% of white patients lived in the lowest income quartile, compared to 50% of Black patients, and 18% of white patients lived in regions with the largest number of individuals without a high school diploma, compared to 44% of Black patients.

Patients residing in low-education and low-income regions had 12% and 13% greater risks of having advanced-stage lung cancer at the time of diagnosis, respectively.

These associations held true for non-Hispanic white, non-Hispanic Black, Hispanic, and Asian patients; those with government and private insurance (but not no insurance); and those treated at any facility type (community, comprehensive community, academic/research, and integrated network facilities).

Black patients in the highest education and income areas, on the other hand, were more likely to have advanced-stage cancer than white patients in the lowest education and income areas.

“Our findings reinforce the notion that poverty is a major contributor to poor lung cancer outcomes,” stated Dr. Akinyemiju. “Importantly, increased money did not always equate to better results for Blacks when compared to whites.”

This underlines the critical need for focused initiatives to provide equal access to smoking cessation and lung cancer screening, as well as increased study into other variables that contribute to the aggressiveness of lung cancer among Blacks.”

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The findings and their consequences are discussed in an accompanying editorial by Erica T. Warner, ScD, MPH, of Massachusetts General Hospital.

“The clustering of non-Hispanic Black and other people of colour in places with higher poverty and lower educational achievement is not coincidence,” Dr. Warner stated.

“These findings, as the authors recognise, reflect the nature and consequences of systemic racism,” she added.

She emphasised the need of proactive, coordinated, community-engaged activities to educate patients and doctors as well as remove patient and community obstacles to enhance lung cancer screening, follow-up, and early detection.

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