Urban/Rural Patterns in Receipt of Treatment for Non-Small Cell Lung Cancer Among Black and White Medicare Beneficiaries, 2000-2003

Background: Receipt of treatment for lung cancer varies by a number of demographic factors, including race/ethnicity and urban/rural residence. We examined urban/rural patterns in receipt of treatment for non-mall cell lung cancer (NSCLC) (ie, surgery, chemotherapy, radiation therapy) among black and white Medicare beneficiaries in Alabama. Methods: After linking Alabama State Cancer Registry data with state Medicare data, we identified 3481 cases of stages I to IV and unknown-stage NSCLC diagnosed from 2000-2002 and obtained their treatment data for 1999-2003. We used bivariate and multivariate analyses to examine racial and urban/rural differences in receipt of treatment. Significant bivariate associations were tested using chi(2) tests. Results: Among beneficiaries with resectable NSCLC (ie, stages I-IIIA), urban whites were more likely to undergo surgical resection than urban blacks (49.3% vs 33.0%, respectively), and more rural whites than rural blacks (49.8% vs 23.9%, respectively) underwent surgery. There was less variation by race and urban/rural residence in the receipt of chemotherapy and radiation therapy. After controlling for age at diagnosis, gender, stage at diagnosis, comorbidity score, and socioeconomic status, the racial disparity for surgery remained. Black beneficiaries in urban counties had 45% lower odds of undergoing surgery than urban white beneficiaries (OR, 0.55; 95% CI, 0.31-0.96), and those in rural counties had 67% lower odds of receiving this treatment than their white counterparts (OR, 0.33; 95% CI, 0.19-0.57). Conclusions: Differences in receipt of surgery exist for both urban and rural black Alabamians with NSCLC. Future studies should explore access to care and perceptions about treatment among lung Cancer patients in this state.