A narrative review of the health disparities associated with malignant pleural mesothelioma

Our plain-English summary of A narrative review of the health disparities associated with malignant pleural mesothelioma, by D.C. Freudenberger, R.D. Shah (Journal of Thoracic Disease, 2021).

The study

• Authors: D.C. Freudenberger, R.D. Shah
• Journal: Journal of Thoracic Disease
• Published: 2021;13(6):3809-3815
• Type of article: Review
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a cancer of the mesothelial lining of the pleura that has traditionally been associated with asbestos exposure in an industrial setting. Asbestos usage has fortunately been banned or phased out in most industrialized countries resulting in its decline in countries such as the United States. Despite this, MPM continues to place significant burden on its affected patients resulting in overall poor prognosis and survival. Questions arise as to what factors, especially what health disparities, contribute to the disease's dismal prognosis. This article will present a narrative review of recent literature that identifies the impact age, sex, race, access to medical centers, and economics have on the diagnosis, treatment, and prognosis of MPM. As will be discussed, research has shown that factors including younger age, female sex, non-white race, private insurance, Medicare, and higher income have been associated with better survival in MPM. Whereas older age, male sex, white race, lack of insurance, and lower income are associated with worse survival. The identification of these and other health disparities related to MPM may allow for future research, clinical guidelines, and policies to be implemented to decrease the burden health disparities create in the diagnosis, treatment, and prognosis of patients with MPM.

2021 Journal of Thoracic Disease. All rights reserved.

In plain English

This article was a narrative review of earlier studies, not new research. The authors searched PubMed for peer-reviewed English-language articles from 1990 to 2019 on how age, sex, race, income, insurance and access to specialist hospitals relate to diagnosis, treatment and survival in malignant pleural mesothelioma. They included 18 articles, 13 with United States data. In one United States database study, female sex was associated with longer survival than male sex (adjusted hazard ratio 0.79, 95% confidence interval 0.75 to 0.82), and a French study found median survival of 18.2 months in women versus 14.1 months in men. Another study linked white race to worse survival (adjusted hazard ratio 1.24, 95% confidence interval 1.18 to 1.30) and a median income of $63,000 or more to better survival. Studies found that older and uninsured patients were less likely to be treated, black patients were less likely to have surgery, and high-volume hospitals followed national treatment guidelines more often than low-volume ones. The authors concluded that causes of these disparities need further study. Most data came from the United States.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of published literature identified through a PubMed search
• Who was studied: 18 peer-reviewed articles published 1990 to 2019, in English. 13 of 18 had United States data; the rest covered global data and data from France, Australia and Italy. 13 of 18 were retrospective studies.
• Exposure: Not an asbestos exposure study. The factors reviewed were patient age, sex, race, socioeconomics and access to care, in relation to diagnosis, treatment and prognosis of malignant pleural mesothelioma.
• Main results:
  • In a 2015 SEER database study by Taioli et al. cited by the review, female sex was independently associated with greater survival than male sex (adjusted HR 0.79, 95% CI 0.75 to 0.82).
  • In a French study cited by the review, women had a median overall survival of 18.2 months and men 14.1 months (P less than 0.001). After adjustment for age and comorbidities, female sex remained a positive prognostic factor (adjusted HR 0.78, 95% CI 0.67 to 0.92).
  • In a cited National Cancer Data Base study (Saddoughi et al.), white race was independently associated with worse overall survival (adjusted HR 1.24, 95% CI 1.18 to 1.30, P less than 0.001).
  • In cited SEER data from 1973 to 2009, 18% of black patients received cancer-directed surgery compared with 24% of white patients (P less than 0.001).
  • In a cited 2017 United States study, only 54% of patients aged 66 years and older received systemic therapy. Comorbidities were not independently associated with whether elderly patients received treatment.
  • In a cited study, uninsured patients were less likely to receive treatment than patients with private insurance (OR 1.93, 95% CI 1.03 to 3.62, P=0.040) or Medicare (OR 2.05, 95% CI 1.08 to 3.86, P=0.027).
  • In the cited Saddoughi et al. study, a median income of $63,000 or more was associated with better survival (adjusted HR 0.84, 95% CI 0.78 to 0.90, P less than 0.001).
  • In a cited 2019 study by Espinoza-Mercado et al., high-volume centers complied with national treatment guidelines more often than low-volume centers (OR 3.58, 95% CI 2.34 to 5.49, P less than 0.001). Academic centers complied more often than nonacademic centers (OR 1.57, 95% CI 1.30 to 1.90).
• The authors' conclusion: The authors concluded that the review identified some disparities affecting patients with malignant pleural mesothelioma. They wrote that the factors contributing to these disparities need continued investigation to improve prognosis and outcomes.
• Limitations the authors state:
  • Most of the articles and data were specific to the United States, so disparities unique to other countries were not discussed in depth.
  • The included articles on health insurance were limited to United States studies.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleura, Asbestos Exposure, Prognosis.

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