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Background: Whether Inuit in Canada experience disparities in lung cancer survival remains unknown. When requiring investigation and treatment for lung cancer, all residents of Nunavik, the Inuit homeland in Quebec, are sent to the McGill University Health Centre (MUHC), in Montréal. We sought to compare survival among patients with lung cancer at the MUHC, who were residents of Nunavik and Montréal, Quebec, respectively., Methods: We conducted a retrospective cohort study. Using lung cancer registry data, we identified Nunavik residents with histologically confirmed lung cancer diagnosed between 2005 and 2017. We aimed to match 2 Montréal residents to each Nunavik resident on sex, age, calendar year of diagnosis, and histology (non-small cell lung cancer v. small cell lung cancer). We reviewed medical records for data on additional patient characteristics and treatment, and obtained vital status from a provincial registry. We compared survival using Kaplan-Meier analysis and Cox proportional hazards regression., Results: We included 95 residents of Nunavik and 185 residents of Montréal. For non-small cell lung cancer, median survival times were 321 (95% confidence interval [CI] 184-626) days for Nunavik ( n = 71) and 720 (95% CI 536-1208) days for Montréal residents ( n = 141). For small cell lung cancer, median survival times were 190 (95% CI 159-308) days for Nunavik ( n = 24) and 270 (95% CI 194-766) days for Montréal residents ( n = 44). Adjusting for matching variables, stage, performance status, and comorbidity, Nunavik residents had a higher hazard of death (hazard ratio 1.68, 95% CI 1.17-2.41)., Interpretation: Nunavik residents experience disparities in survival after lung cancer diagnosis. Although studies in other Inuit Nunangat regions are needed, our findings point to an urgent need to ensure that interventions aimed at improving lung cancer survival, including lung cancer screening, are accessible to Inuit Nunangat residents., Competing Interests: Competing interests: Sarah MacIsaac reports fellowship training grants from Janssen Pharmaceuticals and Boehringer Ingelheim, payment or honoraria from Boehringer Ingelheim, participation on a board for Boehringer Ingelheim, and a role on a Canadian Thoracic Society equity, diversity, and inclusion committee. Nathalie Boulanger is director of professional services, Ungava Tulattavik Health Centre. Nicole Ezer reports grants from Canadian Institutes of Health Research (CIHR), MUHC (McGill University Health Centre) Foundation, and Fonds de recherche du Québec – Santé; consulting fees from the GSK Advisory Board for chronic obstructive pulmonary disease (COPD); speaker fees for AstraZeneca family practice clinic teaching on COPD; speaker fees for GSK family practice clinic teaching on spirometry; and advisor roles on a Ministère de la Santé et des Services sociaux committee on lung cancer screening and Institut national d’excellence en santé et services sociaux committee on lung cancer screening. Anne Gonzalez reports a grant from Lung Cancer Canada, and is chair of the Lung Cancer Section, Thoracic Oncology, and Chest Procedures Network, American College of Chest Physicians. Scott Owen reports consulting fees for being on the advisory boards of AstraZeneca, Bristol Myers Squibb (BMS), Roche, Novocure, and Takeda. Carmela Pepe reports advisory board membership and speaker honoraria from AstraZeneca and Merck, speaker honoraria from BMS, and advisory board membership from Takeda. Jonathan Spicer reports grants to his institution from BMS, Merck, AstraZeneca, Roche, Protalix Biotherapeutics, and CLS Therapeutics, and payments from AstraZeneca, Merck, BMS, Roche, Amgen, Pfizer, Xenetic Biosciences, Protalix Biotherapeutics, BMS, and Eisai. Shirley White-Dupuis receives honoraria from the Research Institute of the McGill University Health Centre for expertise and guidance on lung health research projects as a member of Puvaqatsianirmut, and is chair of the board of directors of the Nunavik Regional Board of Health and Social Services. Larry Watt receives honoraria from the Research Institute of the McGill University Health Centre for expertise and guidance on lung health research as a member of Puvaqatsianirmut, and is also executive director of Ungava Tulattavik Health Centre. Minnie Grey is former executive director of Nunavik Regional Board and Health Social Services. Faiz Ahmad Khan reports grants from CIHR, World Health Organization, Fonds de recherche du Québec – Nature et technologies, National Research Council of Canada, and Observatoire international sur les impacts sociétaux de l’IA et du numérique, funded by the Fonds de recherche du Québec. No other competing interests were declared., (© 2024 CMA Impact Inc. or its licensors.)