# Health System and Contextual Factors Associated with Racial Equity in Lung Cancer Care

> **NIH NIH R01** · YALE UNIVERSITY · 2022 · $629,894

## Abstract

Significance: Non-small cell lung cancer (NSCLC), the leading cause of death from cancer in the U.S., is
plagued by racial disparities across the spectrum of care. Despite the fact that racial cancer disparities are long-
standing and well-described, fundamental knowledge gaps remain. First, the degree to which racial disparities
in NSCLC care and outcomes vary across geographic regions has not been thoroughly explored. Second, little is
known about how contextual factors contribute to racial disparities at the regional level. Historically, health
services research has focused on the healthcare system as the primary driver of racial disparities, with a limited
exploration of contextual factors such as health care segregation and structural racism. Further, it is unclear
how key stakeholders within the healthcare and community settings address and overcome barriers to
equitable NSCLC care. Objective: We will address these critical knowledge gaps, with the overarching goal of
mitigating racial disparities in NSCLC diagnosis, treatment, and outcomes, by identifying modifiable structural
and health system/intermediary factors and strategies that influence equity in lung cancer care. We intend to
conduct an explanatory sequential mixed methods study, combining novel retrospective, population-based
studies of racial disparity in lung cancer care with a positive deviance analysis. Through qualitative interviews
with key stakeholders in regions with high versus low racial disparities, we will reveal strategies and structures
that influence equity in lung cancer care and outcomes. Our hypothesis is that the magnitude of racial
disparities varies substantially across counties, and this variation does not arise by accident – there are specific
contextual factors, such as structural racism, segregation, and health system factors, that exacerbate
disparities. Specific Aims: We propose an explanatory sequential mixed methods study of Medicare
beneficiaries diagnosed with NSCLC from 2013 through 2017: (1) To assess variation in racial disparities in
NSCLC care (non-Latinx Black vs. non-Latinx White) across counties within SEER regions. (2) To assess
structural/foundational factors (e.g. structural racism, socioeconomic inequality) associated with area-level
racial disparities in NSCLC care. (3) To assess health system/intermediary determinants (e.g. hospital
characteristics and competition, patient segregation) of area-level racial disparities in NSCLC care. (4) To
identify stakeholder strategies associated with ensuring equitable NSCLC care in counties that have similar
socioeconomic characteristics, yet higher versus lower racial disparities. The proposed mixed methods study
will have a high impact, using a combination of innovative methods to move beyond traditional health system
factors to identify modifiable structural, socioeconomic, and social factors that contribute to lung cancer
disparities. Furthermore, we will elucidate strategies that stakeholders ...

## Key facts

- **NIH application ID:** 10500846
- **Project number:** 1R01MD017569-01
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** Cary P. Gross
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $629,894
- **Award type:** 1
- **Project period:** 2022-09-21 → 2027-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10500846

## Citation

> US National Institutes of Health, RePORTER application 10500846, Health System and Contextual Factors Associated with Racial Equity in Lung Cancer Care (1R01MD017569-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10500846. Licensed CC0.

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