Influence of comorbidity on racial differences in receipt of surgery among US veterans with early-stage non-small-cell lung cancer

Abstract

Purpose: It is unclear why racial differences exist in the frequency of surgery for lung cancer treatment. Comorbidity is an important consideration in selection of patients for lung cancer treatment, including surgery. To assess whether comorbidity contributes to the observed racial differences, we evaluated racial differences in the prevalence of comorbidity and their impact on receipt of surgery.

Patients and methods: A total of 1,314 patients (1,135 white, 179 black) in the Veterans Health Administration diagnosed with early-stage non-small-cell lung cancer in 2007 were included. The effect of comorbidity on surgery was determined by using generalized linear models with a logit link accounting for patient clustering within Veterans Administration Medical Centers.

Results: Compared with whites, blacks had greater prevalence of hypertension, liver disease, renal disease, illicit drug abuse, and poor performance status, but lower prevalence of respiratory disease. The impact of most individual comorbidities on receipt of surgery was similar between blacks and whites, and comorbidity did not influence the race-surgery association in a multivariable analysis. The proportion of blacks not receiving surgery as well as refusing surgery was greater than that among whites.

Conclusion: Blacks had a greater prevalence of several comorbid conditions and poor performance status; however, the overall comorbidity score did not differ by race. In general, the effect of comorbidity on receipt of surgery was similar in blacks and whites. Racial differences in comorbidity do not fully explain why blacks undergo lung cancer surgery less often than whites.

Fig 1.

Proportion of patients who did not receive surgery according to categories of Adult Comorbidity Evaluation-27 comorbidity score. Table data represent denominator of patients in each Adult Comorbidity Evaluation-27 comorbidity score category.

Fig 2.

Proportion of patients who refused surgery according to categories of Adult Comorbidity Evaluation-27 comorbidity score among patients who did not receive surgery. Table data represent denominator of patients in each Adult Comorbidity Evaluation-27 comorbidity score category among patients who did not receive surgery.