Racial disparities in occupational risks and lung cancer incidence: Analysis of the National Lung Screening Trial

Juon, Hee‐Soon; Hong, Alicia; Pimpinelli, Marcella; Rojulpote, Madhuwani; McIntire, Russell K.; Barta, Julie A.

doi:10.1016/j.ypmed.2020.106355

Cited by 19 publications

(16 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The National Lung Screening Trial found both higher incidence of lung cancer and increased rates of occupational exposure for African Americans compared to White individuals. 20 Similarly, Black patients have also been found to have decreased odds of undergoing surgery for non-small cell lung cancer compared to White patients. 21 Overall racial disparities in mortality after cancer surgery have remained unchanged over past decade.…”

Section: Discussionmentioning

confidence: 99%

“…This builds on prior work showing that when patients with lung cancer receive indicated surgical care, both perioperative and oncologic outcomes improve. 20,22 However, we did not specifically evaluate whether cancer-directed surgery was performed at high surgical volume hospitals or with a high-volume surgeon, both of which would have been associated with improved perioperative and oncologic outcomes. [29][30][31] In addition to the geographic impact of rural place of residence, we also found that increasing local area deprivation was associated with deleterious outcomes.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Rural Disparities in Lung Cancer-directed Surgery

et al. 2021

View full text Add to dashboard Cite

Objective: The primary objective of this study was to determine the influence of rural residence on access to and outcomes of lung cancer-directed surgery for Medicare beneficiaries. Summary of Background Data: Lung cancer is the leading cause of cancerrelated death in the United States and rural patients have 20% higher mortality. Drivers of rural disparities along the continuum of lung cancercare delivery are poorly understood. Methods: Medicare claims (2015–2018) were used to identify 126,352 older adults with an incident diagnosis of nonmetastatic lung cancer. Rural Urban Commuting Area codes were used to define metropolitan, micropolitan, small town, and rural site of residence. Multivariable logistic regression models evaluated influence of place of residence on 1) receipt of cancer-directed surgery, 2) time from diagnosis to surgery, and 3) postoperative outcomes. Results: Metropolitan beneficiaries had higher rate of cancer-directed surgery (22.1%) than micropolitan (18.7%), small town (17.5%), and isolated rural (17.8%) (P < 0.001). Compared to patients from metropolitan areas, there were longer times from diagnosis to surgery for patients living in micropolitan, small, and rural communities. Multivariable models found nonmetropolitan residence to be associated with lower odds of receiving cancer-directed surgery and MIS. Nonmetropolitan residence was associated with higher odds of having postoperative emergency department visits. Conclusions: Residence in nonmetropolitan areas is associated with lower probability of cancer-directed surgery, increased time to surgery, decreased use of MIS, and increased postoperative ED visits. Attention to timely access to surgery and coordination of postoperative care for nonmetropolitan patients could improve care delivery.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rural Disparities in Lung Cancer-directed Surgery

et al. 2021

View full text Add to dashboard Cite

show abstract

“…An approach to quantify the proportion of the association between SES and cancer risk, which is due to other factors, is mediation analysis. Here, we review the potential role of occupation in mediating the association between two important contributors of social inequalities to cancer risk, race/ethnicity and education ( Table 2 [ 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ]).…”

Section: The Mediating Role Of Occupation In the Association Between ...mentioning

confidence: 99%

“…A recent investigation of racial disparities was conducted within the National Lung Screening Trial (NLST) cohort [ 44 ], showing both higher proportions of lung cancer and exposure to carcinogens including asbestos and silica in Blacks than in Whites. The authors reported an overrepresentation of racial and ethnic minorities such as Blacks and Hispanics in material-handling jobs, reflecting a disproportionately large percentage of the workforce exposed to industrial carcinogens.…”

Section: The Mediating Role Of Occupation In the Association Between ...mentioning

confidence: 99%

Role of Occupation in Shaping Cancer Disparities

Collatuzzo

Teglia

Boffetta

2022

Cancers

View full text Add to dashboard Cite

Cancer occurrence is characterized globally by profound socioeconomic differences. Occupation is a fundamental component of socioeconomic status. In this review, we discuss the role of occupation as a determinant of cancer disparities. First, we address the issue of participation in cancer screening programs based on income, health insurance, occupational status and job title. Second, we review the role of occupation in contributing to disparities by acting as a mediator between cancer and (i) education and (ii) race/ethnicity. Lastly, we analyze data from a multicenter case−control study of lung cancer to calculate the mediating role of occupational exposure to diesel exhaust, silica and welding fumes in the association between education and lung cancer. By addressing the complex paths from occupation to cancer inequalities from multiple points of view, we provide evidence that occupational-related characteristics, such as income, health insurance, unemployment and hazardous exposures impinge on cancer control and outcomes. The increasing awareness of these aspects is fundamental and should lead to public health interventions to avoid inequalities rising from occupational factors.

show abstract

“…Case studies reveal specific links between particular occupational hazards and health outcomes, from heat-related illness among farmworkers (Fleischer et al, 2013) to physical trauma among day laborers (Lowry et al, 2010) and hotel workers (Buchanan et al, 2010). Occupations also expose individuals to unequal toxins with effects that may accumulative over time; for example, Juon et al (2021) find that Black workers hold occupations that place them at higher exposure to dangers such as silica and asbestos, which increase the risk of lung cancer.…”

mentioning

confidence: 99%

Quantifying the contribution of occupational segregation to racial disparities in health: A gap-closing perspective

Lundberg¹

2021

Preprint

View full text Add to dashboard Cite

Racism causes racial disparities in health, and structural racism has many components. Focusing on one of those components, this paper addresses occupational segregation. I document high onset of work-limiting disabilities in occupations where many workers identify as non-Hispanic Black or as Hispanic. I then pivot to a causal question. Suppose we took a sample from the population and reassigned their occupations to be a function of education alone. To what degree would health disparities narrow for that sample? Using observational data, I estimate that the disparity between non-Hispanic Black and white workers would narrow by one-third. This estimate is credible because of adjustment for lagged measures of demographics, human capital, and health carried out under transparent causal assumptions. The result contributes to understanding about inequality and health by quantifying the contribution of occupational segregation to a disparity: if we took a sample and reassigned occupations, the disparity would narrow but would not disappear. The paper contributes to methodology by illustrating an approach to macro-level claims (how segregation affects a population disparity) that draws on explicitly causal micro-level analyses (potential outcomes for individuals) for which data are abundant.

show abstract

Racial disparities in occupational risks and lung cancer incidence: Analysis of the National Lung Screening Trial

Cited by 19 publications

References 20 publications

Rural Disparities in Lung Cancer-directed Surgery

Rural Disparities in Lung Cancer-directed Surgery

Role of Occupation in Shaping Cancer Disparities

Quantifying the contribution of occupational segregation to racial disparities in health: A gap-closing perspective

Contact Info

Product

Resources

About