Racial and Gender Disparities in different regions of the United States in patients with metastatic lung and bronchial cancer

Abstract Background: Lung Cancer is the leading cause of cancer deaths in the US, making up almost a quarter of all cancer deaths. Disparities exist upon closer examination: African American (AA) males were found to have a higher incidence of developing lung cancer compared to their Caucasian counterparts. Some plausible reasons for higher incidence rates in AA patients may be due to differences in smoking habits, socioeconomic variables, and metabolism of tobacco carcinogens. Along with these factors, societal differences and lack of resources are postulated to play a significant role. These differences were also observed in clinical trials with an underrepresentation of minorities. A niche deficit exists in outcomes of racial minorities with metastatic lung and bronchial cancer. Methods: Data for this study was obtained from the 2016-18 Nationwide Inpatient Sample (NIS). This is maintained as part of the Health Care Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (AHRQ). It is the largest all-payer inpatient care database in the US and comprises a 20% stratified random sample of all US hospital discharges. Further details: https://www.hcup-us.ahrq.gov/Results: We identified 238,516 patients with Metastatic Lung and bronchial cancer, of which 77.45% were Caucasians, 12.48% AAs, 4.74% Hispanics, and 2.81 % Asians and Pacific Islanders (API). Almost 40% of the study population is from the Southern region, followed by 24.25% in Midwest, 20.56% in the Northeast, and 14.81% in the West. Other race populations had the most reported deaths (10.42%), followed by APIs (10.30%), Native Americans (8.67%), Hispanics (8.75%), AAs (8.66%), and Caucasians (8.34%) (p <0.000). AAs had significantly higher deaths in the South (17.24%) and APIs had significantly higher deaths in the West (12.21%) compared to other regions (p <0.0001). With and without adjusting all the other variables, AAs (OR = 1.069 (1.046 - 1.091)), APIs (OR = 1.230 (1.184 - 1.278)), Native Americans (OR = 1.207 (1.091 - 1.336)), and Others (OR = 1.300 (1.250 - 1.351)) have significantly higher odds of dying when compared to Caucasians.The odds of all-cause mortality for African Americans and Asians and Pacific Islanders remain higher in comparison in all the regions. Conclusions: Racial minorities remain at higher odds of all-cause mortality in all regions, and focused programs to improve their access to healthcare, insurance and resources should help alleviate these disparities.