Exploring social, environmental, and health correlates of lung and bronchus cancer incidence in HMNCC catchment area

Background: Lung and bronchus cancer drives cancer mortality in the Houston Methodist Neal Cancer Center (HMNCC) catchment area, with profound geographic and racial disparities threatening health equity. The eight-county catchment area exhibits stark variations in demographics, industrial exposures, and health resource access. Characterizing community-level drivers of this excess risk is imperative for targeted prevention strategies that address these inequities. Methods: County level cancer incidence (2018-2022) was collected through U.S. Cancer Statistics. The sociodemographic, clinical, behavioral, and environmental factors were obtained from the CDC PLACES and ACS 5-year estimates. GIS mapping identified the spatial patterns within the 8 counties: Harris, Montgomery, Fort Bend, Galveston, Brazoria, Chambers, Liberty, and Jefferson. Weighted Spearman correlations (population-weighted) and weighted univariate linear regressions of the log transformed incidence were used to assess the associations. Holm adjustment controlled for multiple testing. Results: The population-weighted median incidence of lung and bronchial cancer in the eight counties was 77.6 per 100,000 (IQR: 77.6-77.6), with the county-wide rate ranging from 32.5 to 77.6 per 100,000. GIS analyses showed consistently elevated incidence in Liberty, Jefferson, and Chambers counties, with Black residents experiencing the highest race-specific burdens. Several factors exhibited strong positive correlations with incidence, including obesity (r=0.998), depression (r=0.984), binge drinking (r=0.976), asthma (r=0.893), and COPD (r=0.721) (all raw p≤0.05). After Holm adjustment, obesity, depression, and binge drinking remained significant. Strong negative correlations were observed for the population under 18 (r= -0.839), Black (r= -0.767), and Asian race (r= -0.723), although none survived Holm correction. In weighted univariate regression, depression showed the strongest association with incidence (beta=0.102, SE=0.013, p<0.001), followed by obesity (beta=0.078, SE=0.016, p=0.003) and binge drinking (beta=0.129, SE=0.032, p=0.007). Associations for asthma (beta=0.288, SE=0.078, p=0.010) and COPD (beta=0.130, SE=0.047, p=0.032) were also significant. Sensitivity analyses using non-parametric models produced nearly identical rankings. Conclusion: Across the HMNCC catchment, lung cancer incidence clusters geographically and align closely with modifiable behavioral and clinical risk indicators, especially depression, obesity, and binge drinking. These findings highlight priority communities and population-level factors for targeted prevention, early detection, and community-engaged interventions aimed at reducing inequities in lung cancer burden.