Segregated Black Patients Less Likely To Receive Lung Cancer Surgery Interview with:

Asal Mohamadi Johnson, PhD, MPH Assistant Professor of Epidemiology, Integrative Health Science Stetson University DeLand, FL 32723

Dr. Asal Mohamadi Johnson

Asal Mohamadi Johnson, PhD, MPH
Assistant Professor of Epidemiology, Integrative Health Science
Stetson University
DeLand, FL 32723 What is the background for this study?

Dr. Johnson: Public health research is primarily focused on neighborhood poverty and racial disparities by illustrating differences between white and black individuals or communities. For example, it has been established that African Americans have higher cancer mortality rates and are less likely to receive appropriate treatment that whites. What we wanted to know in this study was the impact of living in segregated areas apart from other area level characteristics such as poverty or education. Instead of solely looking at health disparities between whites and black patients, our study focused on differences in survival among black patients with early stage Non-Small Cell Lung Cancer (NSCLC) living in different levels of neighborhood segregation. Wh\What are the main findings?

Dr. Johnson: We found that black patients who lived in areas with higher levels of segregation were less likely to receive surgery (when compared with black patients living in least segregated areas). Our survival analysis showed black patients who lived in areas with both high levels of poverty and segregation had lower survival rates, even after we controlled for the effect of receiving surgery. We found it surprising that area level poverty by itself did not explain differences in survival among black patients, rather its effect was seen only when combined with segregation. What should clinicians and patients take away from your report?

Response: This study has more implications for community level interventions and public policy to address the underlying factors, such as racial segregation, that contribute to health disparities. Reducing such disparities would improve patient outcome particularly for minority patients. What recommendations do you have for future research as a result of this study?

Dr. Johnson: It is becoming more common to control for area level poverty in cancer disparity research. We recommend the use of other neighborhood characteristics, including segregation; as a common practice in cancer studies to elucidate the different social aspects of cancer care disparity. It is important to communicate to lung cancer patients that with utilization of post-cancer care regimens the chance of survival increases. However, we need to realize when structural barriers exist for black patients, they may not be able to utilize such care. The combination of poverty and segregation likely restricts access to quality medical care. Many health disparities are likely a product of structural disparities in the U.S. with deep roots in social and political systems. Conversation, action and political commitment are necessary and should continue on how to remove such barriers and improve the overall conditions for those living in racially segregated areas. Is there anything else you would like to add?

Dr. Johnson: The study should be considered within its limitations. It is important to keep in mind that most variables of this study are area level, not individual level variables. Additionally, we did not have data on the cause of death. This was an important limitation of this study. Also, there are multiple ways of measuring segregation, all of which have some advantages and disadvantages. Thank you for your contribution to the community.


M. Johnson et al. The Effects of Residential Segregation and Neighborhood Characteristics on Surgery and Survival in Patients with Early-Stage Non-Small Cell Lung Cancer,Cancer Epidemiology Biomarkers & Prevention(2016).
DOI: 10.1158/1055-9965.EPI-15-1126

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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