Black lung cancer patients diagnosed at early stages-for which surgical resection offers a potential cure-experience worse overall survival than their White counterparts. We undertook a population-based study to estimate the racial and ethnic disparity in death from competing causes and assessed its contribution to the gap in overall survival among early-stage lung cancer patients.

We collected survival time data for 105,121 early-stage (IA, IB, IIA, and IIB) Hispanic, non-Hispanic Asian, non-Hispanic Black, and non-Hispanic White lung cancer patients diagnosed between 2004 and 2013 from the Surveillance, Epidemiology, and End-Results registries. We modeled survival time using competing risk regression and included as covariates sex, age at diagnosis, race/ethnicity, stage at diagnosis, histology, type of surgical resection, and radiation sequence.

Adjusting for demographic, clinical, and treatment characteristics, non-Hispanic Blacks experienced worse overall survival compared to non-Hispanic Whites (adjusted hazard ratio [aHR]: 1.05; 95% confidence interval [CI]: 1.02,1.08) while Hispanics and non-Hispanic Asians experienced better overall survival (aHR=0.93; 95% CI: 0.89, 0.98 and aHR=0.82; 95% CI: 0.79, 0.86, respectively). Worse survival from competing causes of death, such as CVD and other cancers-rather than from lung cancer itself-led to the disparity in overall survival among non-Hispanic Blacks (adjusted relative risk=1.07; 95% CI: 1.02, 1.12).

Narrowing racial and ethnic disparities in survival among early-stage lung cancer patients will rely on more than just equalizing access to surgical resection and will need to include better management and treatment of smoking-related comorbidities and diseases.