Structural Racism Linked to Lung Cancer Care Disparities

This study examined whether structural racism at the county level influences racial disparities in the care and outcomes of patients with non–small cell lung cancer (NSCLC), the most common type of lung cancer. The researchers investigated two measures of structural racism: deprivation (the Structural Racism Effect Index, SREI) and racial dissimilarity (County Structural Racism Index, CSR). 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 structural racism—defined as systemic inequities embedded in societal institutions—affects these disparities is critical for improving care equity. By identifying how factors such as county-level resources and racial inequities impact lung cancer care, this research could guide efforts to reduce racial health disparities and improve survival rates for Black patients.

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 of structural racism, including the SREI (a measure of resource deprivation) and the CSR (a measure of racial inequity 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 fared worse than white patients across all outcomes. They were less likely 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 structural racism, as measured by the CSR, 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% disparity. Statistically significant racial disparities were observed (P < .05).

These findings highlight the role of structural racism in perpetuating health inequities. While white patients’ outcomes sometimes improved in counties with high racial inequity, Black patients’ outcomes did not show similar benefits. This suggests that systemic inequities disproportionately disadvantage Black patients, even within the same geographic regions. Addressing these disparities requires targeting structural factors, such as inequities in housing, education, and healthcare access, to improve cancer care quality and equity.