Racial disparities in the Treatment of Stage I Non-Small Cell Lung Cancer Among Native Hawaiian and Pacific Islander Populations

Surgery is the standard of care for Stage I non-small cell lung cancer (NSCLC), however, rates of surgical treatment among racial minority groups, particularly Native Hawaiian (NH) and other Pacific Islander (PI) populations, remain underexplored. This study investigates treatment and survival of NH and PI patients with early-stage NSCLC.

A retrospective analysis of 1,115 patients diagnosed with Stage I NSCLC at Queen's Medical Center from 2000 to 2022 was conducted. Patients were categorized by race (White, Asian, NH, PI). The likelihood of receiving surgery was assessed using univariate and multivariate logistic regression models adjusted for age, gender, insurance status, and histology. Survival differences were analyzed using Kaplan-Meier estimates and Cox proportional hazard models.

Among the 1,115 patients diagnosed with Stage I NSCLC, the racial distribution included 284 White patients, 649 Asian patients, 153 Native Hawaiian (NH) patients, and 29 other Pacific Islander (PI) patients. NH and PI patients were less likely to undergo surgery compared to Whites. In multivariate models, NH patients had 47% lower odds of receiving surgery compared to Whites (OR 0.53, 95% CI 0.34–0.83, p=0.015), and PI patients had 71% lower odds (OR 0.29, 95% CI 0.12–0.70, p=0.006). Asians had similar surgery rates to Whites (OR 0.95, 95%CI 0.67-1.35, p=0.767). Rates of surgery were also significantly associated with insurance type (less frequent among Medicare/uninsured OR 0.56, 95%CI 0.35-0.88, p=0.012), age (less frequent among older patients), histology (less frequent among squamous histology, OR 0.53, 95%CI 0.40-0.74, p<0.001), and gender (more frequent among female OR 1.34 95%CI 1.00-1.79, p=0.052). Median survival was 75.9 months for Whites, 82.3 months for Asians, 66.4 months for NH, and 69.2 months for PI (p=0.514). In adjusted models, Asians demonstrated better survival than Whites (OR 0.77, 95% CI 0.64–0.94, p=0.010). No significant survival differences were observed between NH, PI, and Whites after adjustment for treatment.

Native Hawaiian and Pacific Islander patients are significantly less likely to undergo surgery for Stage I NSCLC compared to Whites, even after adjusting for key demographic and clinical factors. These disparities highlight the need for targeted interventions to improve access to and utilization of standard-of-care treatment in NH and PI populations, potentially reducing racial inequities in lung cancer outcomes.