Lung Cancer in Patients Under 50: What is the Role of Social Determinants of Health?

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer Pub Date : 2025-02-20 DOI:10.1016/j.cllc.2025.02.011

Fatima G Wilder, Miles McAllister, Anupama Singh, Yue Xie, Emanuele Mazzola, Michael T Jaklitsch

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引用次数: 0

Abstract

Background: Black patients present with non-small-cell lung cancer (NSCLC) at younger ages, and Black race is a poor prognostic factor. We aimed to identify specific socioeconomic factors that may contribute to these disparities.

Methods: The National Cancer Database (NCDB) was queried for NSCLC cases (2000-2020). Patients were grouped into 3 categories: 18 to 44(A), 45 to 49(B) and 50 to 90 years(C). Demographics, tumor characteristics, survival, insurance status, distance from the treating hospital, median household income, and proportion of residents without a high school diploma (HSD) were compared.

Results: There were 1,703,062 patients, 77,107 of whom were under 50-years-old. Compared to White patients, more Black patients in A and B presented at stage IV (A: 39.7% vs. 35%; B: 40.9% vs. 35%), had higher 90-day mortality (A: 2.7% vs. 2.2%; B: 4% vs. 2.7%) and were uninsured (A: 14.2% vs. 9.6%; B: 14.8% vs. 10.2%). Additionally, more Black patients in A (38.2% vs. 18.2%) and B (42% vs. 18%) were from regions with fewer high school graduates and where the median income was in the lowest quartile (A: 45.2% vs. 18.3%; B: 48.8% vs. 19.4%). Black patients lived closer to treating hospitals and were more often seen at academic centers. Despite this, Black patients under 50 years presented more frequently with stage IV disease and were commonly from disadvantaged settings compared to White patients.

Conclusions: Interventions on social determinants such as education and income might address some of the disparities surrounding NSCLC in young Black patients.

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背景：黑人患者罹患非小细胞肺癌（NSCLC）的年龄较小，黑人种族是预后不良的因素。我们旨在找出可能导致这些差异的特定社会经济因素：我们查询了美国国家癌症数据库（NCDB）中的 NSCLC 病例（2000-2020 年）。患者被分为三类：18至44岁(A)、45至49岁(B)和50至90岁(C)。对患者的人口统计学特征、肿瘤特征、存活率、保险状况、与治疗医院的距离、家庭收入中位数以及没有高中文凭的居民比例（HSD）进行了比较：共有 1,703,062 名患者，其中 77,107 人年龄在 50 岁以下。与白人患者相比，A 组和 B 组中更多的黑人患者处于 IV 期（A 组：39.7% 对 35%；B 组：40.9% 对 35%），90 天死亡率更高（A 组：2.7% 对 2.2%；B 组：4% 对 2.7%），并且没有保险（A 组：14.2% 对 9.6%；B 组：14.8% 对 10.2%）。此外，A 组（38.2% 对 18.2%）和 B 组（42% 对 18%）更多的黑人患者来自高中毕业生较少且收入中位数处于最低四分位数的地区（A 组：45.2% 对 18.3%；B 组：48.8% 对 19.4%）。黑人患者住得离治疗医院更近，也更常在学术中心就诊。尽管如此，与白人患者相比，50 岁以下的黑人患者更常出现 IV 期疾病，而且通常来自贫困地区：结论：对教育和收入等社会决定因素的干预可能会解决黑人年轻患者NSCLC的一些不平等问题。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical lung cancer 医学-肿瘤学

CiteScore

7.00

自引率

2.80%

发文量

159

审稿时长

24 days

期刊介绍： Clinical Lung Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of lung cancer. Clinical Lung Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of lung cancer. The main emphasis is on recent scientific developments in all areas related to lung cancer. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.