Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Michaela Dinan

Second Advisor

Leah M. Ferrucci

Abstract

Importance: The approval of immune checkpoint inhibitors (ICI) has improved survival amongthose with metastatic non-small cell lung cancer (mNSCLC). However, it is unclear to what extent existing racial and ethnic disparities in survival outcomes for those with mNSCLC are widening under the new ICI treatment era. Objective: Examine changes in racial and ethnic disparities in mNSCLC survival rates before and after the U.S Food and Drug Administration (FDA) approval of ICI in the United States. Design, Setting, and Participants: This study is a population-based retrospective cohort of patients with NSCLC from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2020), which consists of 17 registries in the United States. The pre-ICI time period for the study was 2010-2014, and the post-ICI time period was 2016-2020. Main Outcomes and Measures: Median cause-specific survival and 2-year difference-in- difference survival analysis was calculated using accelerated failure time models. We evaluated the association between race and ethnic categories and time periods with an interaction term. Race and ethnic categories included non-Hispanic White (NHW), non-Hispanic Black (NHB), non-Hispanic Asians/Pacific Islander (NHAPI), and both Hispanic and non-Hispanic American Indians/Alaska Natives (HNHAI). Results: The study sample included 24,445 patients. The 2-year survival rate increased from the Pre-ICI to Post-ICI period among NHW (Pre-ICI = 13.8% and Post-ICI = 23.0%), NHB (Pre-ICI = 13.1% and Post-ICI = 21.2%), HNHAI (Pre-ICI = 14.6% and Post-ICI = 24.7%), with NHAPI having the highest survival in both periods (Pre-ICI = 24.4% and Post-ICI = 35.1%). Survival disparities were not significantly different from pre-ICI to post-ICI 2 Conclusion: We did not observe any evidence of ICI widening the racial and ethnic disparity gap among those with mNSCLC from pre-ICI to post-ICI.

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This is an Open Access Thesis.

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