Disparities in time to treatment initiation of invasive lung cancer among Black and White patients in Tennessee

• Published in: PloS one Vol. 20; no. 1; p. e0311186
• Main Authors: Mamudu, Lohuwa, Sulley, Saanie, Atandoh, Paul H., Reyes, Joanne L., Bashar, Raquibul A. K. M., Whiteside, Martin, McEligot, Archana J., Mamudu, Hadii M., Williams, Faustine
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 03.01.2025; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Bivariate analysis; Black lung; Black or African American - statistics & numerical data; Cancer; Cancer patients; Cancer therapies; Care and treatment; Disease; Female; Health maintenance organizations; Healthcare Disparities - statistics & numerical data; HMOs; Human subjects; Humans; Insurance; Invasiveness; Lung cancer; Lung diseases; Lung Neoplasms - ethnology; Lung Neoplasms - pathology; Lung Neoplasms - therapy; Male; Marital status; Medical prognosis; Medical research; Medicine, Experimental; Middle Aged; Mortality; Patients; Physiological aspects; Pneumonectomy; Population studies; Proportional Hazards Models; Registries; Risk; Social aspects; Sociodemographics; State laws; Statistical models; Subgroups; Surgery; Tennessee - epidemiology; Time-to-Treatment - statistics & numerical data; Variables; Variance analysis; White; White People - statistics & numerical data; Tennessee; United States; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0311186

Early initiation of treatment for lung cancer has been shown to improve patient survival. The present study investigates disparities in time to treatment initiation of invasive lung cancer within and between Black and White patients in Tennessee. A population-based registry data of 42,970 individuals (Black = 4,480 and White = 38,490) diagnosed with invasive lung cancer obtained from the Tennessee Cancer Registry, 2005-2015, was analyzed. We conducted bivariate ANOVA tests to examine the difference in time to treatment initiation among independent factors, and multivariable Cox proportional hazard models to identify independent factors that influence median time to treatment initiation after diagnosis. When considering the estimate of the proportion of time to treatment initiation based on the combined influence of all independent factors (sex, age, race, marital, county of residence, health insurance, cancer stage, and surgical treatment), Black patients were generally more at risk of delayed treatment compared to Whites. Black patients aged <45 years (adjusted hazard ratio [aHR] = 1.40; 95% confidence interval [CI] = 1.01-1.94) and married White patients (aHR = 1.13; 95% CI = 1.07-1.18) had the highest increased risk of late treatment among their respective racial subgroups. In the general sample, patients with private health insurance had (aHR = 1.08; 95% CI = 1.01-1.16) higher risk of late treatment beyond 2.7 weeks compared to self-pay/uninsured patients. This was consistent among both Black and White subsamples. Patients with localized and regional lung cancer stages had a decreased risk of delayed treatment compared to those diagnosed at the distant stage among both Black and White patients. Black patients were often at greater risk of late initiation of treatment for invasive lung cancer in Tennessee. Additional research is needed to understand factors influencing time to treatment initiation for Black patients in Tennessee. Further, cancer care resources are needed in Black communities to ensure timely treatment of invasive lung cancer, reduce disparities, and promote equitable care for all cancer patients.