Race and health disparities in patient refusal of surgery for early-stage non-small cell lung cancer: A SEER cohort study

Introduction. Several factors, including race, age, stage, comorbid conditions, social support, and socioeconomic status, have been linked to the likelihood of a patient having surgery for early-stage non-small cell lung cancer (NSCLC). The aim of the present study is to determine the influence of race and health disparities on refusal of recommended potentially curative surgery. Methods. The Surveillance, Epidemiology, and End Results (SEER) database was used to create a cohort of 62,514 patients diagnosed with stages I and II NSCLC between 1988 and 2002, of whom 51,938 were recommended for surgery. The outcome variable was refusal of recommended surgical treatment, while race was the key predictor variable. Potential confounders were adjusted for in the hierarchical generalized logistic regression analysis. Results. A majority was White (86%) and underwent surgery (81%). About 2% of Blacks (n = 109), 1.4% of Whites (n = 756), and 2.8% of "other" race individuals (n = 96) refused surgery. In the multivariable adjusted model, Blacks [odds ratio (OR) 1.95, 95% confidence interval (CI) 1.5, 2.3, P < 0.001] and those of "other" race (OR 2.03, 95% CI 1.5, 2.5, P < 0.001) had greater odds of refusing surgery than did Whites. Increasing age, male gender (OR 1.17, P = 0.031), and being unmarried (OR 2.1, P < 0.001) were other factors associated with higher odds of refusal. Significant county variations were also noted in refusal of surgery. Conclusions. Blacks and "other" races are more likely to refuse recommended surgery for early-stage NSCLC compared with Whites. Future studies should focus on exploring potential reasons for refusal and developing communication interventions.