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Hispanics/Latinos in the Bronx Have Improved Survival in Non-Small Cell Lung Cancer Compared with Non-Hispanic Whites

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Abstract

Background

Hispanics/Latinos are a growing yet understudied population in the United States (US). Despite lower socioeconomic status, Hispanics/Latinos tend to have similar or better health outcomes than Non-Hispanic Whites (NHWs). This phenomenon has not been conclusively studied for lung cancer.

Methods

Using a cohort of patients at Montefiore Medical Center (MMC) in the Bronx, NY, we examined factors related to lung cancer survival by race/ethnicity with an emphasis on Hispanics/Latinos. Subjects were diagnosed with non-small cell lung cancer (NSCLC) between 2004 and 2017. Demographic and clinical data were obtained from MMC’s clinical systems and tumor-related information from MMC/Einstein’s Cancer Registry. Survival was assessed using Cox proportional hazards modeling adjusted for clinical and sociodemographic factors including smoking. Factors related to survival within each major racial/ethnic group were examined.

Results

Hispanics/Latinos experienced decreased risk of death relative to NHWs [hazard ratio (HR) = 0.70, 95% confidence interval (95%CI) 0.57–0.86] overall and by sex (males: HR = 0.78, 95%CI 0.59–1.03, females: HR = 0.61, 95%CI 0.44–0.86). Decreased risk among Hispanics/Latinos relative to NHWs was evident in never-smokers (HR = 0.55, 95%CI 0.29–1.01), ever-smokers (HR = 0.72, 95%CI 0.57–0.90), younger subjects (HR = 0.73, 95%CI 0.54–0.99), and older subjects (HR = 0.72, 95%CI 0.53–0.97). Surgery was associated with improved survival in Hispanics/Latinos (HR = 0.60, 95%CI 0.43–0.85), and smoking with worse survival (HR = 1.56, 95%CI 1.02–2.39). Survival did not differ between Non-Hispanic Blacks and NHWs.

Conclusions

In a poor urban community, Hispanics/Latinos experience improved survival from NSCLC compared to NHWs, which is not entirely explained by smoking. Future research should investigate the drivers of this benefit and differences in survival by Hispanic/Latino origin.

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Acknowledgements

We would like to thank Dr. Aileen McGinn, who provided insight on data analysis that greatly assisted the research.

Funding

This work was supported in part by NIH/National Center for Advancing Translational Science (NCATS) Einstein-Montefiore CTSA Grant Number ULITR001073. The funder had no direct role in the conduct of this study.

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Authors and Affiliations

  1. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA

    Madelyn Klugman, Xiaonan Xue, Mindy Ginsberg, Thomas Rohan & H. Dean Hosgood III

  2. Division of Medical Oncology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 1695 Eastchester Road, Bronx, NY, 10461, USA

    Haiying Cheng

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  1. Madelyn Klugman
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  2. Xiaonan Xue
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Contributions

M.K conducted the study under the direction of H.D.H. X.X. provided insight and guidance with respect to statistical methods. M.G. provided insight and guidance with respect to electronic medical record data. M.K., X.X., M.G., H.C., T.R., and H.D.H. discussed the results and contributed to the final manuscript.

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Correspondence to Madelyn Klugman.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Institutional Review Board at Albert Einstein College of Medicine, reference number 043574) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Klugman, M., Xue, X., Ginsberg, M. et al. Hispanics/Latinos in the Bronx Have Improved Survival in Non-Small Cell Lung Cancer Compared with Non-Hispanic Whites. J. Racial and Ethnic Health Disparities 7, 316–326 (2020). https://doi.org/10.1007/s40615-019-00660-2

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