Study links lower regional income and education to higher likelihood of advanced lung cancer diagnosis

Lung cancer is the leading cause of cancer-related death in the United States, and early detection and treatment are key to prolonging patient survival. A recent study published by Wiley online in Cancera peer-reviewed journal from the American Cancer Society, found that area-level education and income are associated with the stage of patients’ lung cancer at diagnosis.

Research has shown that patients with lower income and education levelsand those living in more socio-economically disadvantaged areas, disproportionately experience lung cancer survival. Racial/ethnic minorities in the United States also face higher lung cancer death rates.

To understand the relationship between Socioeconomic status and stage of lung cancer at diagnosis, and how this association may vary by race/ethnicity and access to Health care, a team led by Tomi F. Akinyemiju, Ph.D., MS, of Duke University School of Medicine, analyzed data from the 2004-2016 National Cancer Database of US patients aged 18-89 who have been diagnosed with any stage of non-small cell lung cancer. The investigators also collected information on the education and income levels of the areas in which the patients resided, as well as details on the patients’ health insurance status and where they received care.

Among the 1,329,972 patients in the study, 17% of white patients were residents of areas in the lowest income quartile, compared to 50% of black patients, and 18% of white patients resided in areas with the highest proportion of adults without a high school diploma, compared to 44% of black patients.

Patients living in less educated areas and lower income areas had a 12% and 13% higher risk, respectively, of having advanced lung cancer at the time of diagnosis. These associations persisted in non-Hispanic white, non-Hispanic black, Hispanic, and Asian patients; those with government and private insurance (but not without insurance); and those treated in any type of facility (community, comprehensive community, academic/research and integrated network facilities). However, black patients residing in the highest education and income areas were more likely to have advanced stage cancer than their white counterparts in the lowest education and income areas.

“Our results confirm that poverty is a root cause of poor lung cancer outcomes,” Dr. Akinyemiju said. “Surprisingly, for blacks, higher income does not necessarily translate to better outcomes compared to whites. This highlights the urgent need for targeted efforts to ensure equitable access to smoking cessation and testing. lung cancer, and further research into other factors that promote lung cancer aggressiveness in blacks.”

An accompanying editorial by Erica T. Warner, ScD, MPH, of Massachusetts General Hospital, discusses the findings and their implications. “The segregation and concentration of non-Hispanic blacks and other people of color in areas of greater poverty and lower educational attainment is no coincidence,” Dr. Warner wrote. “As the authors acknowledge, these findings reflect the nature and impacts of structural racism.” She stressed the need for proactive, coordinated and community-based efforts to educate the patients and clinicians, and to overcome patient and community barriers to improve screening, monitoring and early recognition of lung cancer symptoms.