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Socioeconomics Behind Blacks' Lung Cancer Mortality Rates

Study says other factors, not race, explain earlier deaths

FRIDAY, Feb. 22, 2002 (HealthDayNews) -- Blacks are more likely than others to die of lung cancer within a year of starting treatment, but the difference doesn't appear to be the result of race.

Rather, a new study says, economic and social factors that worsen their prognosis when they're diagnosed with the disease may account for the disparity. Blacks are less likely than others with lung cancer to be working, to have private insurance, and to have other important social and economic supports that improve their chances of receiving timely medical care.

"People have said that maybe African-Americans had a worse tumor biology, but this data says that it's not true. I think they get in the system late for a plethora of reasons," says Dr. A. William Blackstock, a Wake Forest University cancer specialist and lead author of the study. A report on the findings appears in the latest issue of the Journal of the National Cancer Institute.

Dr. Camara Jones, of the Association of Black Cardiologists, calls the study "laudable" in its effort to divorce race from socioeconomic factors in health outcomes. "Race is not biology," Jones says. "It's a social construct."

Lung cancer is the nation's leading cancer killer, claiming more than 150,000 lives a year. Although the disease can be cured if caught early, the outlook is grim for patients with advanced cases.

Researchers have long known that blacks with lung tumors do worse than whites and other ethnic groups with the disease. However, whether that has been because of an innate racial or ethnic predisposition to severe lung cancer hasn't been clear.

The latest study suggests access to health care and poor socioeconomic conditions -- not genetics -- are to blame for the disparity.

Blackstock and his colleagues compared outcomes in 504 people with advanced non-small-cell lung cancer, enrolled in treatment trials at various hospitals between 1989 and 1998. Of those, 46 were black, 442 were white, and the rest belonged to other ethnic groups.

One year after starting treatment, 22 percent of the black people were still alive, compared with 30 percent of the others, the researchers say.

All the subjects had roughly the same tumor stage -- a measure of size and spread -- when entering the trials. However, blacks were more likely than the others to be weak before starting treatment -- 83 percent versus 60 percent. In addition, they were also much more likely to have lost large amounts of weight before diagnosis -- 41 percent versus 27 percent. Both of these factors are known to worsen prognosis, Blackstock says, and probably reflect how long a person has had the tumors.

Indeed, after accounting for weight loss and vigor, the impact of race on prognosis evaporated, the researchers say.

Blacks were less likely to be employed, and they were more likely to be disabled and covered by Medicaid, the government's health insurance program for the poor. Each of these could help explain why their survival rate was worse than that of the others, the researchers say.

Strikingly, Blackstock notes, the black people were more than twice as likely to be unmarried as the others in the study.

"Simply having someone there to help you through made a difference. If you don't have someone to get your medication, to get you to your appointments, to keep you eating as you should, you don't do as well," he explains.

Blackstock says taking steps to resolve the disparity will benefit blacks and whites alike. One approach, for example, would be to make sure that everyone, regardless of income, has access to drugs that prevent weight loss: "If they're having trouble buying medications that help with weight loss, maybe they should get them for free."

What To Do

A recent government report found that while disparities in minority health care are becoming less glaring, "not all groups have benefited equally, and substantial differences among racial/ethnic groups persist."

To learn more about minority health matters, try the Department of Health and Human Service's Office of Minority Health Resource Center.

For more on lung cancer, try the American Lung Association.

SOURCES: Interviews with A. William Blackstock, M.D., assistant professor, radiation oncology, Wake Forest University School of Medicine, Winston-Salem, N.C.; Camara Jones, M.D., M.P.H., Ph.D., director, epidemiolgy and clinical trials center, Association of Black Cardiologists, Atlanta; Feb. 20, 2002, Journal of the National Cancer Institute
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