{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T16:14:28Z","timestamp":1779293668113,"version":"3.51.4"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n The degree to which structural racism is associated with racial disparities in lung cancer care and outcomes is unknown.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the association between 2 measures of structural racism and quality of care and outcomes for Black and White patients with non\u2013small cell lung cancer (NSCLC) and whether this association differs by patient race.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional study was a retrospective analysis of Medicare beneficiaries diagnosed with NSCLC between 2013 and 2019 using Surveillance, Epidemiology, and End Results Program and Medicare data. Patient inclusion criteria were age older than 67 years at the time of diagnosis, continuous fee-for-service Part A and B Medicare coverage for 24 months before through 12 months after diagnosis, NSCLC histology, and non-Hispanic Black or non-Hispanic White race and ethnicity. The data analysis was performed between September 1, 2024, and April 1, 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Two county-level measures of structural racism: the Structural Racism Effect Index, which measures deprivation, and County Structural Racism, which assesses racial dissimilarity between Black and White patients across multiple domains.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The dichotomous outcomes included localized stage at diagnosis, stage-appropriate evaluation and treatment, and 2-year survival. Multivariable mixed-effects logistic regression was used to assess the association between each structural racism measure and outcome, including interaction terms to determine whether structural racism moderated the association between patient race and NSCLC care and outcomes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 54\u202f344 patients (mean [SD] age, 77.7 [6.6] years; 51.6% female), 10.3% were Black and 89.7% were White. A lower proportion of Black patients compared with White patients were diagnosed at a localized stage (30.9% vs 38.4%), received stage-appropriate evaluation and treatment (20.3% vs 28.0%), and survived 2 years after diagnosis (28.7% vs 36.6%). Among White patients, 2-year survival was significantly higher in counties in the highest dissimilarity quintile (estimated probability, 36.8%) vs the lowest (estimated probability, 30.4%), while there was no difference for Black patients (26.8% vs 27.8%). Accordingly, while there was no significant difference in probability of 2-year survival between Black and White patients in the lowest dissimilarity quintile, the disparity was significant in the highest quintile (\u221210.0%; 95% CI, \u221212.2% to \u22127.7%).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This cross-sectional study of racial disparities in NSCLC care found that residence in counties with higher structural racism (as measured by the dissimilarity index) was associated with lower mortality among White patients but not among Black patients. Quantifying structural racism and its association with cancer care delivery may identify targets that allow for improvement in quality of cancer care and mitigation of disparities.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.13919","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T15:30:30Z","timestamp":1779291030000},"page":"e2613919","source":"Crossref","is-referenced-by-count":0,"title":["County-Level Structural Racism Indices and Racial Disparities in Lung Cancer Care"],"prefix":"10.1001","volume":"9","author":[{"given":"Jacquelyne J.","family":"Gaddy","sequence":"first","affiliation":[{"name":"Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale Cancer, Center, New Haven, Connecticut"},{"name":"Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Do H.","family":"Lee","sequence":"additional","affiliation":[{"name":"Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale Cancer, Center, New Haven, Connecticut"},{"name":"Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeph","family":"Herrin","sequence":"additional","affiliation":[{"name":"Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale Cancer, Center, New Haven, Connecticut"},{"name":"Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James B.","family":"Yu","sequence":"additional","affiliation":[{"name":"Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale Cancer, Center, New Haven, Connecticut"},{"name":"Department of Radiation Oncology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig E.","family":"Pollack","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorraine T.","family":"Dean","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoff B.","family":"Dougherty","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maureen E.","family":"Canavan","sequence":"additional","affiliation":[{"name":"Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale Cancer, Center, New Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela R.","family":"Soulos","sequence":"additional","affiliation":[{"name":"Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale Cancer, Center, New Haven, Connecticut"},{"name":"Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cary P.","family":"Gross","sequence":"additional","affiliation":[{"name":"Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale Cancer, Center, New Haven, Connecticut"},{"name":"Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut"},{"name":"Yale National Clinician Scholars Program, New Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"issue":"1","key":"zoi260408r1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.32471\/exp-oncology.2312-8852.vol-44-no-1.17411","article-title":"Current therapeutic strategies and challenges in NSCLC treatment: a comprehensive review.","volume":"44","author":"Kumar","year":"2022","journal-title":"Exp Oncol"},{"issue":"1","key":"zoi260408r2","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3322\/caac.21763","article-title":"Cancer statistics, 2023.","volume":"73","author":"Siegel","year":"2023","journal-title":"CA Cancer J Clin"},{"issue":"8","key":"zoi260408r3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtocrr.2022.100374","article-title":"Racial and ethnic trends and disparities in NSCLC.","volume":"3","author":"Primm","year":"2022","journal-title":"JTO Clin Res Rep"},{"issue":"1","key":"zoi260408r4","doi-asserted-by":"publisher","DOI":"10.1093\/jncics\/pky007","article-title":"Racial disparities in time from diagnosis to treatment for stage I non-small cell lung cancer.","volume":"2","author":"Holmes","year":"2018","journal-title":"J Natl Cancer Inst Cancer Spectr"},{"issue":"10077","key":"zoi260408r5","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(17)30569-X","article-title":"Structural racism and health inequities in the USA: evidence and interventions.","volume":"389","author":"Bailey","year":"2017","journal-title":"Lancet"},{"issue":"4","key":"zoi260408r6","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1016\/j.amepre.2020.05.019","article-title":"Measuring structural racism and its association with BMI.","volume":"59","author":"Dougherty","year":"2020","journal-title":"Am J Prev Med"},{"issue":"6","key":"zoi260408r7","doi-asserted-by":"publisher","first-page":"1054","DOI":"10.1097\/SLA.0000000000006156","article-title":"Residential redlining, neighborhood trajectory, and equity of breast and colorectal cancer care.","volume":"279","author":"Loehrer","year":"2024","journal-title":"Ann Surg"},{"issue":"6","key":"zoi260408r8","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.3146","article-title":"Factors associated with cancer disparities among low-, medium-, and high-income US counties.","volume":"1","author":"O\u2019Connor","year":"2018","journal-title":"JAMA Netw Open"},{"issue":"5","key":"zoi260408r9","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.70757","article-title":"Mediators of racial inequities in non-small cell lung cancer care.","volume":"14","author":"Hamid","year":"2025","journal-title":"Cancer Med"},{"issue":"12","key":"zoi260408r10","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.39593","article-title":"Neighborhood and individual socioeconomic disadvantage and survival among patients with nonmetastatic common cancers.","volume":"4","author":"Cheng","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"3","key":"zoi260408r11","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1002\/cncr.22826","article-title":"Racial disparities and socioeconomic status in association with survival in a large population-based cohort of elderly patients with colon cancer.","volume":"110","author":"Du","year":"2007","journal-title":"Cancer"},{"issue":"12","key":"zoi260408r12","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1200\/JCO.20.02602","article-title":"Persistent disparity: socioeconomic deprivation and cancer outcomes in patients treated in clinical trials.","volume":"39","author":"Unger","year":"2021","journal-title":"J Clin Oncol"},{"issue":"4","key":"zoi260408r13","doi-asserted-by":"publisher","first-page":"212","DOI":"10.3322\/caac.20121","article-title":"Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths.","volume":"61","author":"Siegel","year":"2011","journal-title":"CA Cancer J Clin"},{"issue":"10","key":"zoi260408r14","doi-asserted-by":"publisher","first-page":"1374","DOI":"10.1377\/hlthaff.2023.00659","article-title":"Measuring the enduring imprint of structural racism on American neighborhoods.","volume":"42","author":"Dyer","year":"2023","journal-title":"Health Aff (Millwood)"},{"issue":"1","key":"zoi260408r16","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1097\/MLR.0000000000001216","article-title":"Validity of race and ethnicity codes in Medicare administrative data compared with gold-standard self-reported race collected during routine home health care visits.","volume":"58","author":"Jarr\u00edn","year":"2020","journal-title":"Med Care"},{"issue":"1","key":"zoi260408r17","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/00005650-199801000-00004","article-title":"Comorbidity measures for use with administrative data.","volume":"36","author":"Elixhauser","year":"1998","journal-title":"Med Care"},{"issue":"7","key":"zoi260408r18","doi-asserted-by":"publisher","first-page":"980","DOI":"10.1093\/gerona\/glx229","article-title":"Measuring frailty in Medicare data: development and validation of a claims-based frailty index.","volume":"73","author":"Kim","year":"2018","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"8","key":"zoi260408r19","doi-asserted-by":"publisher","first-page":"4826","DOI":"10.1245\/s10434-023-13449-9","article-title":"Disparities in socioeconomic factors mediate the impact of racial segregation among patients with hepatopancreaticobiliary cancer.","volume":"30","author":"Munir","year":"2023","journal-title":"Ann Surg Oncol"},{"issue":"6","key":"zoi260408r20","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1007\/s10552-018-1027-y","article-title":"Racialized economic segregation and stage at diagnosis of colorectal cancer in the United States.","volume":"29","author":"Scally","year":"2018","journal-title":"Cancer Causes Control"},{"issue":"5","key":"zoi260408r21","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1001\/jamaoncol.2021.8116","article-title":"Mediators of racial disparity in the use of prostate magnetic resonance imaging among patients with prostate cancer.","volume":"8","author":"Leapman","year":"2022","journal-title":"JAMA Oncol"},{"issue":"4","key":"zoi260408r22","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1097\/SLA.0000000000005375","article-title":"Structural racism and breast cancer-specific survival: impact of economic and racial residential segregation.","volume":"275","author":"Goel","year":"2022","journal-title":"Ann Surg"},{"issue":"12","key":"zoi260408r23","doi-asserted-by":"publisher","first-page":"1958","DOI":"10.1158\/1055-9965.EPI-19-0416","article-title":"The impact of neighborhood economic and racial inequalities on the spatial variation of breast cancer survival in New Jersey.","volume":"28","author":"Wiese","year":"2019","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"2","key":"zoi260408r24","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1377\/hlthaff.2021.01394","article-title":"Systemic and structural racism: definitions, examples, health damages, and approaches to dismantling.","volume":"41","author":"Braveman","year":"2022","journal-title":"Health Aff (Millwood)"},{"issue":"6","key":"zoi260408r25","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.16740","article-title":"Cancer burden in neighborhoods with greater racial diversity and environmental burden.","volume":"8","author":"Bobbitt","year":"2025","journal-title":"JAMA Netw Open"},{"issue":"3","key":"zoi260408r26","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1016\/j.jval.2017.09.002","article-title":"Sensitivity of claims-based algorithms to ascertain smoking status more than doubled with meaningful use.","volume":"21","author":"Huo","year":"2018","journal-title":"Value Health"},{"key":"zoi260408r27","doi-asserted-by":"publisher","first-page":"S55","DOI":"10.1080\/14622200310001649478","article-title":"The African Americanization of menthol cigarette use in the United States.","volume":"6","author":"Gardiner","year":"2004","journal-title":"Nicotine Tob Res"},{"issue":"3","key":"zoi260408r28","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1136\/tc-2024-058718","article-title":"Neighbourhood inequities in the availability of retailers selling tobacco products: a systematic review.","volume":"34","author":"Kong","year":"2025","journal-title":"Tob Control"},{"issue":"2","key":"zoi260408r29","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1377\/hlthaff.2021.01466","article-title":"Structural racism in historical and modern US health care policy.","volume":"41","author":"Yearby","year":"2022","journal-title":"Health Aff (Millwood)"},{"key":"zoi260408r15","unstructured":"Dyer Z. Structural racism effect index. 2025. Accessed March 11, 2026. https:\/\/www.sreindex.com\/background"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2849161\/gaddy_2026_oi_260408_1778598198.23926.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T15:30:32Z","timestamp":1779291032000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2849161"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,20]]},"references-count":29,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.13919","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,20]]}}}