Lung Cancer Disparities in the United States: The Role of Smoking, Comorbidities, Socioeconomic Status, and Regional Variation

Background Lung cancer disproportionately affects certain racial and regional populations in the United States, with notable disparities observed among patients hospitalized with this diagnosis. This study examines disparities in clinical characteristics, socioeconomic distribution, and hospital outcomes among adults hospitalized with lung cancer. Methods A retrospective analysis was performed using the 2019-2020 National Inpatient Sample (NIS). Patients with a primary diagnosis of lung cancer were evaluated across racial groups and U.S. regions. Key variables included smoking status, comorbidity burden, length of stay (LOS), in-hospital mortality, and total hospital charges. Results White patients demonstrated the highest prevalence of smoking, whereas Black patients experienced the longest LOS. Hispanic patients had the highest total hospital charges. Regionally, lung cancer admissions were most common in the South, which also showed lower socioeconomic status and reduced access to screening. In unadjusted analyses, in-hospital mortality did not differ significantly by hospital region; however, after multivariable adjustment, patients hospitalized in the South had significantly lower odds of in-hospital mortality compared with those hospitalized in the Northeast. Socioeconomic status showed a graded association, with progressively lower mortality risk among patients in higher income quartiles. Conclusions Significant racial and regional disparities exist in lung cancer burden and hospital outcomes. Targeted interventions addressing socioeconomic barriers, screening inequities, and comorbidity management are needed to reduce these disparities.