Racial/ethnic disparities in non-small cell lung cancer mortality in the USA, 2000–2020: a population-based study

BACKGROUND: Non-small cell lung cancer (NSCLC) remains the leading cause of cancer-related deaths in the USA. While racial and ethnic disparities in outcomes are known, long-term trends and the specific contribution of clinical and socioeconomic factors remain unclear. AIM: To quantify the long-term racial/ethnic disparities in NSCLC mortality (2000-2020) and assess the relative contribution of modifiable clinical and socioeconomic factors to these inequities. DESIGN: A retrospective population-based cohort study. METHODS: Data for 548 526 NSCLC patients diagnosed between 2000 and 2020 were extracted from the Surveillance, Epidemiology and End Results (SEER) database. Cumulative incidence of death was analysed using the Fine and Gray model. Multivariable cause-specific hazard regression quantified the contribution of stage, tumor grade, treatment status and household income to racial/ethnic disparities. RESULTS: The 5-year cumulative mortality rate was highest among Black patients (83.5%), followed by American Indian/Alaska Native (AI/AN, 82.0%), White (79.5%), Hispanic (79.5%) and Asian or Pacific Islander (API, 77.1%) patients. Cancer-directed surgery, stage at diagnosis and household income were significant contributors to disparities, explaining up to 29.04% of Black-White and 19.97% of AI/AN-White disparities in all-cause mortality. Relative disparities decreased over time, but absolute disparities widened, particularly between Black and White patients. CONCLUSIONS: Significant racial and ethnic disparities in NSCLC mortality have persisted over the past two decades. Addressing modifiable factors like late-stage diagnosis and ensuring equitable access to high-quality, cancer-directed treatments are essential steps toward promoting health equity.