LAUSR

BACKGROUND Prior research demonstrated statistically significant racial disparities related to lung cancer treatment and outcomes. We examined differences in initial imaging and survival between Blacks, Hispanics and non-Hispanic Whites. METHODS The linked Surveillance, Epidemiology, and End Results-Medicare database between 2007 and 2015 was used to compare initial imaging modality for patients with lung cancer. Participants included 28,881 non-Hispanic Whites, 3,123 Black, and 1,907 Hispanics, patients age ≥66 years who were enrolled in Medicare fee-for-service and diagnosed with lung cancer. The primary outcome was comparison of PET/CT utilization between groups. A secondary outcome was 12-month cancer specific survival. Information on stage, treatment, and treatment facility were included in the analysis. Chi-Square test and logistic regression were used to evaluate factors associated with imaging utilization. Kaplan-Meier method and Cox proportional hazards regression were used to calculate adjust hazard ratios and survival. All statistical tests were two-sided. RESULTS After adjusting for demographic, community, and facility characteristics, Blacks were less likely to undergo PET/CT imaging at diagnosis compared to non-Hispanic Whites odds ratio (OR) 0.54; 95% CI 0.50, 0.59; P < 0.001). Hispanics were also less likely to receive PET/CT imaging (OR 0.72; 95% CI 0.65, 0.81 P < 0.001). PET/CT was associated with improved survival (HR = 0.61; 95% CI: 0.57, 0.65, P < 0.001). CONCLUSION Blacks and Hispanics are less likely to undergo guideline recommended PET/CT imaging at diagnosis of lung cancer, which may partially explain differences in survival. Awareness of this issue will allow for future interventions aimed at reducing this disparity.