Study Quantifies How Social and Structural Factors Drive Racial Inequities in NSCLC Care

Black patients with non-small cell lung cancer (NSCLC) in the US experience significantly worse care and outcomes compared with White patients, and these disparities are largely explained by exposure to structural racism across the health care continuum, according to a study published in Cancer Medicine.

The study aimed to quantify how specific social and structural factors mediate racial inequities in NSCLC care and survival using a large national dataset and a mediation analysis grounded in the socioecological model of health.

“Through this analysis, we hope to inform phase-specific levers of change along the continuum of NSCLC care,” wrote Safraz Hamid, Department of Surgery, Yale School of Medicine, Yale National Clinician Scholars Program in New Haven, Connecticut, USA, and coauthors.

The researchers conducted a retrospective cohort study using the SEER-Medicare database, focusing on 69 130 patients aged 67 years or older diagnosed with NSCLC between 2013 and 2019. Of these, 5679 were non-Hispanic Black and 63 451 were non-Hispanic White. The study analyzed 5 key outcomes: stage at diagnosis, stage-appropriate evaluation, stage-appropriate treatment, receipt of optimal care, and 2-year survival. Mediators included indicators of health status, health care access, socioeconomic status (SES), and racial and economic segregation.

Black patients were consistently less likely than White patients to receive high-quality care. They were less often diagnosed at a localized stage (33.2% vs 40.7%), received less stage-appropriate evaluation (35.1% vs 42.2%) and treatment (48.7% vs 59.4%), and had lower 2-year survival (29.2% vs 36.1%). These disparities remained even after adjusting for demographics.

Mediation analysis showed that up to 94.2% of the racial disparity in 2-year survival could be explained by the selected mediators. The strongest single mediator across outcomes was Medicare-Medicaid dual eligibility, which explained 25.0% of the disparity in survival and over 20% of the gap in treatment. The Index of Concentration at the Extremes (ICE), a measure of racialized economic segregation, accounted for 17.2% of the disparity in receiving stage-appropriate evaluation. Lack of access to influenza vaccination and primary care visits also played significant roles, as did neighborhood education levels and poverty rates.

“Importantly, the factors that mediate these racial inequities vary in relative strength along the NSCLC care continuum, suggesting that interventions to mitigate inequities should be tailored to the specific phase of care,” concluded the study authors.

Reference

Hamid SA, Lee DH, Herrin J, et al. Mediators of racial inequities in non-small cell lung cancer care. Cancer Med. 2025;14(5):e70757. doi:10.1002/cam4.70757