The effects of residential segregation and neighborhood characteristics on surgery and survival in patients with early-stage non?small cell lung cancer

Abstract

Background: Although the negative effects of lower socioeconomic status on non?small cell lung cancer (NSCLC) treatment and survival have been widely studied, the impact of residential segregation on prognosis and the receipt of treatment has yet to be determined. Methods: This is a retrospective, cohort study ofNSCLC patients in Georgia (2000?2009; n = 8,322) using data from the Georgia Comprehensive Cancer Registry. The effects of segregation, economic deprivation, and combined segregation/deprivation on the odds of receiving surgery were examined in separate multilevel models. To determine the association for the exposures of interest on the risk of death for different racial groups, separate multilevel survival models were conducted for black and white patients. Results: Living in areas with the highest [AOR = 0.35, 95% confidence interval (CI), 0.19?0.64] and second highest (AOR = 0.37, 95% CI, 0.20?0.68) levels of segregation was associated with decreased odds of receipt of surgery. Black patients living in areas with high residential segregation and high economic deprivation were 31% (95% CI, 1.04?1.66) more likely to die, even after surgery was controlled for. For white patients, economic deprivation was associated with decreased odds of surgery but not survival. Segregation had no effect. Conclusion: Our findings suggest how black and white individuals experience segregation and area-level poverty is likely different leading to differences in adverse health outcomes. Impact: Identifying neighborhood characteristics impacting health outcomes within different racial groups could help reduce health disparities across racial groups by implementing targeted policies and interventions.