Tuesday, March 07, 2006

Veterans Health Care and Increased Lung Cancer Mortality Among Black Males

Cancer Epidemiology Biomarkers & Prevention Vol. 15, 25-31, January 2006

Unlimited Access to Care: Effect on Racial Disparity and Prognostic Factors in Lung Cancer

Charles R. Mulligan1, Amir D. Meram4,3, Courtney D. Proctor4, Hongyu Wu3, Kangmin Zhu3 and Aizen J. Marrogi4,2

Divisions of 1 Cardiothoracic Surgery and 2 Anatomic Pathology; 3 Departments of Surgery, Pathology, and Area Laboratory Services and U.S. Military Cancer Institute, Walter Reed Army Medical Center, Washington, District of Columbia; and 4 Laboratory of Biomarkers and Carcinogenesis, CBCP-IRC 2 Department of Surgery, Uniformed Services University for Health Sciences, Bethesda, Maryland

Requests for reprints: Aizen J. Marrogi, Division of Anatomic Pathology, Department of Pathology and Area Laboratory Services, Walter Reed Army Medical Center, Room #4710A, 6900 Georgia Avenue, Northwest, Washington, DC 20307-5001. Phone: 202-792-5781; Fax: 202-782-3217. E-mail: Aizen.Marrogi@na.amedd.army.mil

Study Objective: Evaluate the prognostic factors influencing lung cancer survival under a universal health care system and determine if access to care eliminates clinical outcome disparity.

Design: Retrospective case series review.

Background: Lung cancer survival is worse in men and in African Americans, thought to be related to poor general health in men and limited access to heath care in African Americans. The Military Health Care System, with unlimited access to care, provides an excellent setting for evaluating gender and racial disparities in lung cancer survival.

Methods: Lung cancers diagnosed at Walter Reed Army Medical Center, from 1990 to 2000, were evaluated by chart review for age, gender, race, smoking history, cancer history, histology, stage, and completeness of resection.

Results: Seven hundred thirteen Caucasians and 173 African Americans,... had a 22% 5-year survival. Cox model analysis showed that male gender [hazard ratio (HR, 1.31) ...predicted poor outcome; whereas ... smoking cessation >7 years (HR, 0.70) were predictors of favorable outcome. No ethnic differences in survival were observed.

Conclusions: No racial disparities in survival when access to medical care is universal. Male gender, incomplete resection, and advanced stage are significant predictors of poor outcome in lung cancer. (Cancer Epidemiol Biomarkers Prev 2006;15(1):25–31)

BrooklynDodger(s) comments: Higher lung cancer mortality among non-white males, compared to whites, is unexplained. Generally, smoking doesn't explain
the difference. Another reason might be unequal access to medical care, although poor survival of lung cancer even with good care suggests this difference might not be important.

The main finding in this study was the 22% 5-year survival on diagnosis. Not good news. The blacks in this study were substantially younger than the whites on entry, and the black males had more advanced tumors. Controlling or all that, there was no difference in survival between the races. But there's no explanation for why the blacks were coming in with more advanced tumors.

The title "Unlimited Access to Care" is maybe overstated. There aren't differential economic barriers to care across the races, but there may be cultural barriers.

The study doesn't test whether access to care is an issue at all in the differences in lung cancer mortality.

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