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How racial segregation affects lung cancer surgery

For African-American cancer patients, segregation could be fatal.

A new study released Tuesday found that blacks in Georgia who lived in the most racially segregated neighborhoods were much less likely to undergo potentially life-saving lung cancer surgery than people who lived in areas that were the least segregated by race.

Lung cancer
National Cancer Institute | Science Photo Library | Getty Images

The study found that black patients who lived in the most segregated neighborhoods were 65 percent less likely to receive non–small cell lung cancer surgery than people in the least segregated areas.

Blacks in the second-most segregated neighborhoods were 63 percent less likely to get that surgery, according to the study, published in Cancer, Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

NSCLC is the most common form of lung cancer by far, and can sometimes be cured if diagnosed in the early stage, and if a patient undergoes surgery. At least half of patients who undergo surgery for NSCLC survive more than five years, but most patients who don't get the surgery died within a year, the study noted.

The same research also found that the likelihood of whites getting the cancer surgery was not affected by whether they lived in an area that was largely black, but it was significantly affected by the general level of education in the neighborhood.

Whites who lived in areas with the lowest-educated people were 48 percent less likely to get NSCLC surgery than people who lived in the most educated areas, the study found.

"Living in areas with higher economic deprivation was associated with lower odds of receiving surgery for both black and white patients," the study found.

The study, which looked at data from the Georgia Comprehensive Cancer Registry from 2000 to 2009, defined segregation based on an index that measured the probability of living near people from the same racial and ethnic group. The study also used economic deprivation as another variable, since it and segregation often are linked.

Study author Asal Mohamadi Johnson noted that prior research has "established that black patients have higher cancer mortality rates and are less likely to receive appropriate treatment than whites."

But "our study focused on difference in survival among black patients resulting from different levels of neighborhood segregation," said Johnson, an assistant professor of integrative health science at Stetson University.

"We suspect the combination of poverty and segregation likely restricts access to quality medical care," she said. "Many health disparities are likely a product of structural disparities in the U.S. with deep roots in social and political systems."

The study noted that the black patients analyzed in Georgia were 43 percent less likely to get NSCLC surgery than white patients, across all areas.

Blacks also had lower rates of five-year survival from the disease than whites, according to the study. "Blacks have a 20 percent increased risk of death compared with white patients when adjusted only for patient characteristics," the study noted.

But that disparity "disappeared after adjustment for surgery and its interaction with combined segregation deprivation," the study found.

In other words, when blacks were living in less segregated communities and received the surgery, their death rates were in line with their white counterparts.

But blacks who lived in the most segregated areas with high levels of economic deprivation were 31 percent more likely to die than other blacks with lung cancer living in areas that were the least segregated and least economically deprived.