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Disparate Access to Surgery for Operable Carcinoma of the Lung in North Carolina

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Disparities in access to surgical care are associated with poorer outcomes in patients with cancer. We sought to determine whether vulnerable populations undergo an expected rate of surgery for Stage I-IIIA lung cancer in North Carolina (NC).

Methods

We calculated the proportional surgical ratio (PSR) to identify a potential disparity in surgery rates for early stage (I-IIIA) lung cancer, first in the five counties with the worst health outcomes (LRC) and subsequently the entire state. The reference was the five healthiest counties (HRC), initially, and then the single county with the best health outcomes.

Results

In 2016, 3,452 individuals with Stage I-IIIA lung cancer were diagnosed in NC of which 246,854 resided in LRC, whereas 1,865,588 resided in HRC. A total of 453 operable lung cancers were diagnosed in the HRC and 107 in the LRC. The observed lobectomy rate in HRC was 40.1% (range 20.2-58.3%) of early-stage lung cancer and 19% (range 12-36%) for LRC. The PSR was 0.65 (95% confidence interval [CI] = 0.35, 0.90). For all 99 counties across NC, the PSR ranged from 0.33 to 0.96 (mean = 0.49, standard deviation [SD] = 0.10). In a multivariable model, only other primary care provider ratio (relative rate per 100 increase = 0.997; 95% CI = 0.994, 0.999) was significantly associated with PSR.

Conclusions

Individuals residing in LRC in NC are 42% less likely to undergo surgery for operable lung cancer than patients living in HRC. Understanding how factors impact access is key to designing informed interventions.

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Acknowledgment

The authors thank the North Carolina Central Cancer Registry, State Center for Health Statistics, Division of Public Health, North Carolina Department of Health and Human Services for providing the age adjusted lung cancer rates by county for North Carolina.

Funding

No funding.

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Authors and Affiliations

  1. Department of Cardiovascular Science, Division of Thoracic Surgery, Brody School of Medicine at East, Carolina University, Greenville, NC, USA

    Aundrea L. Oliver M.D.

  2. Department of Surgery, Brody School of Medicine at East, Carolina University, Greenville, NC, USA

    Caitlin Takahashi-Pipkin D.O.

  3. Department of Surgery, Division of Surgical Research, Brody School of Medicine at East Carolina University, Greenville, NC, USA

    Jan H. Wong M.D. & William D. Irish Ph.D.

  4. Department of Internal Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA

    Ashley E. Burch Ph.D.

  5. Department of Health Services and Information Management, East Carolina University, Greenville, NC, USA

    Ashley E. Burch Ph.D.

  6. Department of Public Health, East Carolina University, Greenville, NC, USA

    William D. Irish Ph.D.

Authors
  1. Aundrea L. Oliver M.D.
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  2. Caitlin Takahashi-Pipkin D.O.
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  3. Jan H. Wong M.D.
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  4. Ashley E. Burch Ph.D.
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  5. William D. Irish Ph.D.
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Corresponding author

Correspondence to Jan H. Wong M.D..

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Disclosure

Dr. Oliver is a board member for the Lung Cancer Initiative, a nonprofit organization for lung cancer awareness for which she receives no financial compensation.

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Presented in part at the 2021 Surgical Forum of the American College of Surgeons Clinical Congress.

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Oliver, A.L., Takahashi-Pipkin, C., Wong, J.H. et al. Disparate Access to Surgery for Operable Carcinoma of the Lung in North Carolina. Ann Surg Oncol 29, 7485–7493 (2022). https://doi.org/10.1245/s10434-022-12101-2

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  • DOI: https://doi.org/10.1245/s10434-022-12101-2

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