Abstract
<title>Abstract</title> <p> <bold>Introduction</bold> : Pulmonary neuroendocrine neoplasms (PNENs) are rare malignancies with increasing incidence. While racial disparities in cancer outcomes are well-known, their patterns in PNENs remain poorly understood. <bold>Materials and Methods</bold> : This population-based cohort study analyzed data from the US SEER database (2000–2019) for patients with a first primary PNEN. Absolute and relative disparities in all-cause, cancer-specific, and non-cancer mortality were assessed. Sequential adjustment and mediation analyses evaluated contributions of demographic, socioeconomic, tumor, and treatment factors. <bold>Results</bold> : Among 125,932 patients, significant racial disparities were observed. Cancer-specific survival improved for all groups, with the greatest gains among Non-Hispanic Black patients. Conversely, disparities in non-cancer survival widened, with Black patients experiencing the largest disadvantage. Asian/Pacific Islander patients consistently showed survival advantages. Histology modified these disparities; Black patients had marked disadvantages in carcinoid tumors but improved survival in small cell carcinoma. Mediation analyses identified disparities in surgical access and marital status as key contributors to survival disadvantages among Black patients with carcinoids. <bold>Conclusion</bold> : Although cancer survival has improved, disparities in non-cancer mortality are widening. These inequities are largely driven by modifiable factors like surgical access. Interventions targeting equitable treatment and comorbidity management are urgently needed to reduce survival disparities in PNENs. </p>