Please cite this article in press as: Biswas T, et al. Important prognostic factors for lung cancer in tobacco predominant Eastern North Carolina: Study based on a single cancer registry. Lung Cancer (2014), http://dx.doi.org/10.1016/j.lungcan.2014.01.026 ARTICLE IN PRESS G Model LUNG-4539; No. of Pages 5 Lung Cancer xxx (2014) xxx–xxx Contents lists available at ScienceDirect Lung Cancer jou rn al hom epage: www.elsevier.com/locate/lungcan Important prognostic factors for lung cancer in tobacco predominant Eastern North Carolina: Study based on a single cancer registry Tithi Biswas a,* , Paul Walker b , Tarun Podder a , Julian Rosenman c , Jimmy Efird d a Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH 44106, United States b Division of Hematology Oncology, Department of Medicine, Leo Jenkins Cancer Center, East Carolina University, Greenville, NC 27834, United States c Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, United States d Center for Health Disparities, Department of Public Health, East Carolina University, Greenville, NC 27834, United States a r t i c l e i n f o Article history: Received 14 October 2013 Received in revised form 30 December 2013 Accepted 29 January 2014 Keywords: Lung cancer Race Effects of insurance Histology Cancer registry Disparity a b s t r a c t Background: It is known that lung cancer incidence and mortality rate are higher in African Americans (AA) than whites. In Eastern North Carolina, there is a higher percentage of AA population than the national average (30.2% vs. 12.4%) and a higher incidence of lung cancer in this region. We investigated demography and survival of lung cancer patients diagnosed and treated in a single institution. Methods: The study includes 2351 patients diagnosed with lung cancer between 2001 and 2010 at East Carolina University. AA and whites were compared by age, sex, race, stage, histology, smoking history and insurance information using chi-square analyses. Patient survival was modeled using Cox proportional hazards regression (SAS version 9.2). Results: The distribution of lung cancer was 70% in whites and 30% in AA. The proportion of AA and whites differed significantly for age, sex, histology, stage, and insurance. Patients aged >70 (p < 0.0001) and 51–70 (p = 0.0064) died sooner than those ≤50 years old. Compared with squamous cell, SCLC had inferior survival (HR = 2.0, 95%CI = 1.7–2.3). Privately insured patients survived longer than those with medicare (p < 0.0001), medicaid (p = 0.0009), or no insurance (p < 0.0001). The survival disadvantage for medicaid (p = 0.0076) and no insurance (p = 0.0033) persisted on multivariable analysis. Race was not a significant predictor of survival on multivariable analysis (p = 0.66). Conclusion: This is one of the largest lung cancer patient populations from a single institution showing demographic differences between the two races with similar survival outcome. Age, histology and type of insurance were strong predictors of survival outcome. Older age, small cell histology and medicaid and no insurance had significantly shorter overall survival. © 2014 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Lung cancer is the second most common cancer among men and women in the United States (US) but is the leading cause of mor- tality in both. The incidence and mortality also can vary based on geographic location within the country. Cancer incidence in North Carolina (NC) is 471.8 per 100,000 of population compared with 465.1 in the US. Similarly, the death rate in NC (189.3) is higher than the US rate (178.1) [1]. * Corresponding author at: Department of Radiation Oncology, University Hos- pitals Seidman Cancer Center, 11100 Euclid Avenue (B-181), Cleveland, OH 44106, United States. Tel.: +1 4402856740. E-mail addresses: tithi.biswas@uhhospitals.org, tithipodder@gmail.com (T. Biswas). The tobacco industry has traditionally been one of the most important industries in North Carolina and a backbone of the state’s agricultural heritage [2]. Because of local tobacco cultivation (Fig. 1), lung cancer is one of the predominant cancers in the state with an incidence of 74.5 (vs. 65.6 in US) per 100,000 resulting in a very large patient population in the region. Although, the annual lung cancer mortality is declining overall, it continues to remain high in racial and ethnic minorities. The out- come of lung cancer based on different race has been published in the literature [3]. It has been well reported that AA have shorter survival and higher mortality than whites in several cancer types including lung cancer. The documented cancer mortality rate in AA is 17% higher than whites [4]. The reason for this disparity still is not well understood. There has been significant controversy in this matter. Whether it is due to true biologic difference between the two races with AA having inherent biologic inferiority is not confirmed. In addition, the differences in insurance status also can 0169-5002/$ – see front matter © 2014 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.lungcan.2014.01.026