County-Level Structural Racism Indices and Racial Disparities in Lung Cancer Care

This study examined whether structural barriers at the county level influence differences in care and outcomes across racial groups among patients with non–small cell lung cancer (NSCLC), the most common type of lung cancer. The researchers investigated two measures: deprivation and racial dissimilarity. They aimed to assess how these measures relate to differences in early diagnosis, appropriate treatment, and survival rates between Black and white patients.

NSCLC is a leading cause of cancer deaths, and Black patients consistently experience worse outcomes than white patients. Understanding how barriers embedded in societal institutions affect these differences in outcomes is critical for improving access to care. By identifying how factors such as county-level resources and differences in access to care affect lung cancer care, this research could guide efforts to improve survival rates and quality of care for Black patients with NSCLC.

The researchers conducted a cross-sectional analysis of over 54,000 Medicare beneficiaries diagnosed with NSCLC between 2013 and 2019. Participants were aged 67 or older and identified as either non-Hispanic Black or non-Hispanic white. The study linked patient data with county-level measures, including a measure of resource deprivation and a measure of racial dissimilarity across domains like housing and education. They examined three outcomes: diagnosis at an early stage, receipt of stage-appropriate care, and two-year survival.

Black patients were less likely than white patients to be diagnosed at an early stage (30.9% vs. 38.4%), receive stage-appropriate treatment (20.3% vs. 28.0%), and survive two years after diagnosis (28.7% vs. 36.6%). Counties with higher racial dissimilarity scores were associated with wider survival gaps between Black and white patients. For example, in counties with the highest racial dissimilarity, the two-year survival rate for Black patients was 26.8%, compared to 36.8% for white patients—a 10 percentage point gap in two-year survival. These differences across racial groups were statistically significant (P < .05).

These findings highlight the role of county-level racial and resource measures in contributing to differences in health outcomes. While white patients’ outcomes sometimes improved in counties with high racial inequity, Black patients’ outcomes did not show similar benefits. This suggests that barriers in these county-level measures disproportionately disadvantage Black patients, even within the same geographic regions. Addressing these gaps in outcomes requires targeting factors such as differences in housing, education, and healthcare access, to improve cancer care quality.

The authors recommend further research to refine these county-level measures and explore their impact on other racial and ethnic groups. They also suggest evaluating interventions aimed at reducing gaps in cancer care and outcomes.

This research was supported by the National Institutes of Health (award R01MD017569) and the National Cancer Institute (award R01HL164116). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Yale University also provided funding and support for this research.