Lung Cancer in Patients under 50: What is the Role of Social Determinants of Health?

Black patients present with non-small-cell lung cancer (NSCLC) at younger ages, and Black race has been shown to be a poor prognostic factor. Data reporting NSCLC cases in the National Cancer Database (NCDB) from 2000 to 2020 was evaluated in 3 categories: 18 to 44(A), 45 to 49(B) and 50-90 years(C). Insurance status, distance from the treating hospital, median household income and proportion of the residents without a high school diploma (HSD) were used as surrogates for socioeconomic factors. Despite being geographically closer to hospitals and being more commonly seen at academic centers, Black patients under 50 years with NSCLC presented more frequently with stage IV disease and are more commonly from disadvantaged settings compared to their White counterparts. This suggests that earlier screening of Black patients may help to address the observed delays in presentation. Background: Black patients present with non-small-cell lung cancer (NSCLC) at younger ages, and Black race is a poor prognostic factor. We aimed to identify specific socioeconomic factors that may contribute to these disparities. Methods: The National Cancer Database (NCDB) was queried for NSCLC cases (2000-2020). Patients were grouped into 3 categories: 18 to 44(A), 45 to 49(B) and 50 to 90 years(C). Demographics, tumor characteristics, survival, insurance status, distance from the treating hospital, median household income, and proportion of residents without a high school diploma (HSD) were compared. Results: There were 1,703,062 patients, 77,107 of whom were under 50-years-old. Compared to White patients, more Black patients in A and B presented at stage IV (A: 39.7% vs. 35%; B: 40.9% vs. 35%), had higher 90-day mortality (A: 2.7% vs. 2.2%; B: 4% vs. 2.7%) and were uninsured (A: 14.2% vs. 9.6%; B: 14.8% vs. 10.2%). Additionally, more Black patients in A (38.2% vs. 18.2%) and B (42% vs. 18%) were from regions with fewer high school graduates and where the median income was in the lowest quartile (A: 45.2% vs. 18.3%; B: 48.8% vs. 19.4%). Black patients lived closer to treating hospitals and were more often seen at academic centers. Despite this, Black patients under 50 years presented more frequently with stage IV disease and were commonly from disadvantaged settings compared to White patients. Conclusions: Interventions on social determinants such as education and income might address some of the disparities surrounding NSCLC in young Black patients.