肺癌是癌症死亡的主要原因，并且不成比例地影响自我认定的黑人或非裔美国人（“黑人”），特别是考虑到他们自我报告的吸烟强度率相对较低。本研究旨在确定吸烟史和肺癌发病风险、组织学、分期和生存率对这些差异的相对影响。我们使用 2 种肺癌模型（密歇根肺癌-所有种族和密歇根肺癌-黑人）来了解为什么黑人的肺癌发病率较高肺癌死亡率。我们研究了不同因素（例如吸烟行为、癌症发展、组织学、诊断分期和肺癌生存率）如何造成这些差异。根据吸烟史进行调整后，总体肺癌死亡人数与黑人之间约 90% 的差异不同人群（1960 年出生）的差异是患肺癌风险差异的结果。肺癌组织学和分期的差异以及生存率的影响很小（各为 4% 至 6%）。尽管 1950 年和 1970 年出生的队列与 1960 年出生的队列在吸烟模式上存在差异，但也观察到了类似的结果。在考虑吸烟因素后，黑人肺癌死亡率较高主要可以解释为：发展为肺癌。然而，随着肺癌治疗和检测的改进，其他因素在确定黑人和总体人群之间肺癌死亡率差异方面可能变得更加重要。为了防止当前的差距变得更严重，重要的是要确保每个人都能以公平的方式获得这些改进。© 作者 2023。由牛津大学出版社出版。版权所有。如需权限，请发送电子邮件至：journals.permissions@oup.com。

Lung cancer is the leading cause of cancer deaths and disproportionately affects self-identified Black or African American ("Black") people, especially considering their relatively low self-reported smoking intensity rates. This study aimed to determine the relative impact of smoking history and lung cancer incidence risk, histology, stage, and survival on these disparities.We used 2 lung cancer models (MichiganLung-All Races and MichiganLung-Black) to understand why Black people have higher rates of lung cancer deaths. We studied how different factors, such as smoking behaviors, cancer development, histology, stage at diagnosis, and lung cancer survival, contribute to these differences.Adjusted for smoking history, approximately 90% of the difference in lung cancer deaths between the overall and Black populations (born in 1960) was the result of differences in the risk of getting lung cancer. Differences in the histology and stage of lung cancer and survival had a small impact (4% to 6% for each). Similar results were observed for the 1950 and 1970 birth cohorts, regardless of their differences in smoking patterns from the 1960 cohort.After taking smoking into account, the higher rate of lung cancer deaths in Black people can mostly be explained by differences in the risk of developing lung cancer. As lung cancer treatments and detection improve, however, other factors may become more important in determining differences in lung cancer mortality between the Black and overall populations. To prevent current disparities from becoming worse, it is important to make sure that these improvements are available to everyone in an equitable way.© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.