Racial segregation may help explain why Black Americans with lung cancer do more poorly than their white counterparts, a new study suggests.
For years, U.S. studies have documented racial disparities in lung cancer. Black Americans are less likely to receive surgery for early-stage lung cancer — the standard of care — and they typically die sooner.
The reasons, however, are not fully clear.
Researchers said the new study implicates residential segregation — a manifestation of structural racism — in the disparities.
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It found that Black lung cancer patients living in the most segregated U.S. counties were 49% more likely to be diagnosed at an advanced stage, compared to those living in the least segregated counties.
And among those with early-stage lung cancer, Black patients in highly segregated areas were 47% less likely to receive surgery.
In the past, racial disparities in health outcomes were often attributed to genetics, according to Dr. Michael Poulson, a resident physician at Boston Medical Center who worked on the study.
“But we all know race is a social construct,” Poulson said.
These findings, he said, highlight the role of historical policies, including “redlining,” that devalued areas with large Black populations. Lack of investment in those areas meant fewer businesses, fewer job opportunities, more poverty, poorer housing and fewer health care facilities.
And the health effects are still being felt, the study suggests.
So while lung cancer is a medical condition, the health care system alone cannot erase racial disparities, said lead author Chandler Annesi, a medical student at Boston University.
“This is extremely hard to change at the health care level,” she said.
Instead, Annesi said, it will take broad efforts — including investments in highly segregated communities and “reparative actions” — to address the nation’s long history of racial discrimination.
Annesi presented the findings at the annual meeting of the Society of Thoracic Surgeons (STS), held online Jan. 29-31. Studies reported at meetings are generally considered preliminary until they are published in a peer-reviewed journal.
Dr. David Tom Cooke is chairman of STS’s Workforce on Diversity and Inclusion. He called the study “novel,” in looking at the issue from the standpoint of residential segregation.
Disparities in lung cancer care and survival are well-established, said Cooke, who is also head of general thoracic surgery at the University of California Davis Health.
