Racial and ethnic disparities in cancer care are well described. Lack of access to primary care physicians (PCPs) may be an important contributor to disparities attributed to race and ethnicity. This study examined the effects of primary care access on mortality in lung cancer (LC) patients (pts) in an underserved community.
Medical records of all pts newly-diagnosed with primary lung cancer between 2012-2016 at a NCI-designated cancer center in the Bronx were reviewed. Demographic data and PCP status were collected. Addresses were correlated with the Health Resources and Services Administration (HRSA) database to identify residences located in primary care shortage areas (PCSAs). Survival data from time of first imaging to death or the end of follow-up on January 1, 2018 were recorded. Data analysis was performed via univariate methods. Survival analysis was performed using Kaplan-Meier and Cox hazards modeling.
Among 1062 pts, 874 (82%) resided in a PCSA, 314 (30%) were Hispanic (H), and 445 (42%) were African-American (AA). Hs and AAs were more likely to reside in PCSAs (p = 0.0002 and p = 0.0008) and in ZIP codes with lower income (both p < 0.0001). Hs and AAs were more likely to depend on public insurance (p = 0.01 and p = 0.02). Pts who live in PCSAs presented at higher stages at the time of diagnosis (p = 0.03) and were diagnosed predominantly in inpatient settings with acute symptoms (p < 0.0001) rather than outpatient clinics (p = 0.0002). In the overall population, PCSA residence (mean: 24 vs. 30 months, p = 0.03, HR = 1.27) and no established PCP (mean: 22 vs. 28 months, p < 0.0001, HR = 1.50) were associated with increased all-cause mortality. In Cox modeling adjusting for stage at diagnosis and PCSA residence, lack of established PCP still predicts increased mortality (p = 0.03, HR = 1.20).
Among new pts with LC, lack of established PCP is associated with increased mortality. Hs and AAs are more likely to reside in PCSAs, suggesting the link between increased mortality and race/ethnicity may be mediated by lack of access to primary care. Our results demonstrate that effective health policy efforts to reduce lung cancer mortality must include approaches to improve access to primary care.
Clinical trial identification
Legal entity responsible for the study
Albert Einstein School of Medicine, Montefiore Medical Center.
Has not received any funding.
All authors have declared no conflicts of interest.