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Race/ethnicity and lung cancer survival in the United States: a meta-analysis

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Abstract

Purpose

Lung cancer mortality has been shown to vary by race and ethnicity in cancer registries; however, studies often do not account for smoking status. We sought to summarize the independent contribution of race and ethnicity to survival in US lung cancer patients, accounting for important variables including smoking status.

Methods

PubMed was used to identify 1,877 potentially eligible studies of which 27 were included. Studies were excluded if they did not account for age, race and/or ethnicity, and smoking status. Fixed- and random-effects meta-analyses were conducted using the reported adjusted hazard ratios (HR) of Hispanic ethnicity and Asian and African-American race compared to Non-Hispanic whites (NHWs) on overall survival in lung cancer.

Results

Hispanic ethnicity and Asian race were associated with decreased adjusted risk of death (Hispanic: Nstudies = 5, Nsubjects = 108,810, HR = 0.95, 95% CI 0.90–1.00; Asian: Nstudies = 6, Nsubjects = 128,950, HR = 0.86, 95% CI 0.81–0.90). The results were similar when excluding studies of solely never-smokers. There was no significant difference in survival between African-American and white race after adjustment (Nstudies = 10, Nsubjects = 131,378, HR = 0.98, 95% CI 0.96–1.01). Other prognostic factors were female gender (HR = 0.88, 95% CI 0.87–0.89), unmarried status (HR = 1.08, 95% CI 1.04–1.11), ever-smoking status (HR = 1.11, 95% CI 1.08–1.15), having comorbidities (HR = 1.39, 95% CI 1.24–1.56), and treatment receipt (surgery: HR = 0.33, 95% CI 0.32–0.34; radiation: HR = 0.87, 95% CI 0.85–0.88; chemotherapy: HR = 0.64, 95% CI 0.63–0.65).

Conclusions

Even after adjustment for clinical factors and smoking status, Hispanics and Asians experienced improved survival compared to NHWs. Future studies are needed to elucidate the drivers of these survival disparities.

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Acknowledgments

This work was supported by NIH/National Center for Advancing Translational Science (NCATS) Einstein-Montefiore CTSA Grant Number ULITR001073.

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Authors and Affiliations

  1. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Madelyn Klugman, Xiaonan Xue & H. Dean Hosgood III

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  1. Madelyn Klugman
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  2. Xiaonan Xue
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Contributions

MK, XX, and HDH conceived and designed the analysis; MK analyzed the data; MK, XX, and HDH contributed to the interpretation of the results and manuscript preparation.

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Correspondence to Madelyn Klugman.

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Klugman, M., Xue, X. & Hosgood, H.D. Race/ethnicity and lung cancer survival in the United States: a meta-analysis. Cancer Causes Control 30, 1231–1241 (2019). https://doi.org/10.1007/s10552-019-01229-4

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