County-Level Study of Lung Cancer Surgery Reveals Disparities

Documenting differences in surgical treatment at the county level contributes invaluable evidence to stimulate corrective health policy changes at all levels.

Researcher: Ahmedin Jemal, DVM, PhD
Institution: American Cancer Society, Data Science 
ACS Research Program: Health Services Research

Lung cancer is the leading cause of cancer-related death in the United States. When lung cancer is diagnosed in its early stages (stage I or II), surgery intended to cure the cancer is usually one part of the standard treatment.

Yet previous research from ACS epidemiologist Ahmedin Jemal, DVM, PhD and others showed that there are differences among US states for who receives surgery due to race, type of health care facility, and geography. Recently, he expanded his research to the county level, which is the common starting point for measuring access to health care in the US and for recognizing the need for more targeted interventions.

Jemal and other researchers, including 4 others from the ACS Surveillance & Health Equity Science program, did a large 7-year study of people diagnosed with early-stage non-small cell lung cancer (NSCLC, the most common type of lung cancer) in about 2,300 counties from 39 states, plus the District of Columbia, and the city of Detroit.

They found that every state—even those with high overall rates of surgeries intended to cure NSCLC—had counties where only a small percentage of NSCLC patients received surgery. The differences between counties was substantially greater than the differences they found between states. The variation was significantly associated with several factors that are potentially modifiable. Those factors included the percentage of people without health insurance and below the federal poverty level, rural/urban status, and surgeon-to-population ratio.

Why does it matter? Documenting differences in surgical treatment at the county level “contributes invaluable evidence to stimulate corrective [health] policy changes” at the federal, state, and county level, the authors said. For instance, expanding Medicaid eligibility and public health programs that target rural communities “may enhance financial well-being, health insurance coverage, and access to health care at the county level,” the authors wrote. County-level studies, they said, can stimulate initiatives that target the improvement of referral or care coordination between nearby counties, regardless of state boundaries.

Read the study.