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J. Harris



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    MO11 - Screening and Epidemiology (ID 131)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      MO11.06 - Minority Status as a Strong Predictor of Health Disparities: A Global Perspective (ID 3296)

      16:15 - 17:45  |  Author(s): J. Harris

      • Abstract
      • Presentation
      • Slides

      Background
      The existence of healthcare disparities by race and ethnicity is well documented, often attributed to a lack of economic and educational parity among groups, and manifested by unequal healthcare access and delivery. Inexplicably however, in many countries the wealthiest and most educated populations have the worst health outcomes. We hypothesize that minority status within a country rather than race, ethnicity, socioeconomics or educational level is more closely associated with poor health outcomes globally and functions independently of other variables.

      Methods
      Minority and majority populations in 34 countries/territories were evaluated for smoking prevalence and age-adjusted lung cancer incidence rates. A global, systematic review of over 1000 sources of epidemiological data was performed using rigorous screening criteria including only national data in original form (national cancer registry, census, or health surveys), from an official government agency, or from peer-reviewed publications. Relative risks (RR) of smoking and lung cancer were computed for all minority groups with the majority population as the referent null. Relative wealth based on median per capita income and relative schooling based on educational attainment were also calculated. Minority groups were only included if so defined by both the Minority Rights Group International and the CIA World Fact Book.

      Results
      Data were collected from approximately 60% of the global population including all six WHO world regions and every populated continent. The RR of smoking for at least one minority group was greater than that of the referent majority in every country or territory analyzed. The RR of lung cancer for at least one minority group was greater than that of the referent majority in all but three countries/territories. These results were remarkably consistent and durable with RR ≥ 1.0 for smoking prevalence and lung cancer incidence in nearly all countries despite minority status being defined differently in many nations whether by race, ethnicity, religion, language, indigenous affiliation, or immigrant status. These results were further corroborated by age-specific lung cancer incidence for selected countries/territories. Racial and socioeconomic status differentials were insufficient explanations for these observations. In the U.S., for example, blacks are generally less wealthy and educated than whites and have higher smoking prevalence and lung cancer incidence rates. However, in neighboring Bermuda and distant South Africa where blacks are the majority, whites have both higher smoking prevalence and lung cancer incidence rates despite being far wealthier and educated. This relationship of increased smoking and lung cancer rates in wealthier, more educated minorities is replicated in nine of the 34 countries in this study.

      Conclusion
      Our results show an empirical relationship between minority status and both increased smoking prevalence and lung cancer incidence rates in minority populations globally. This suggests that minority status may be a potent, behavioral driver leading to elevated health risks in minority populations around the world. Moreover, minority status seems to be independent of traditional socioeconomic variables, and alone may be a powerful predictor of disparate health outcomes in many diverse nations, distinctive societies, and unique cultures on a global scale.

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