Age, Race, and Income Are Associated With Lower Screening Rates at a Safety Net Hospital

Steiling, Katrina; Loui, Taylor; Asokan, Sainath; Nims, Sarah; Moreira, Paulo César; Rebello, None Anuradha; Litle, Virginia R.; Suzuki, Kei

doi:10.1016/j.athoracsur.2019.11.052

Cited by 40 publications

(40 citation statements)

References 23 publications

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“…Their work showed that among those eligible for screening, non-black patients were 2.8-times more likely to be screened than black patients (28). Similar disparities were described in a recently published analysis of patients at an academic safety net hospital by Steiling et al (12). Although these authors reported a relatively high overall screening rate in their eligible patient cohort (16.1%), they found that black patients were significantly less likely than white patients to receive LDCT screening…”

Section: Race/ethnicitysupporting

confidence: 59%

“…Despite the clear survival benefit of LDCT screening in appropriate patients, there has been a relatively low adherence to these guidelines in clinical practice (8)(9)(10). In addition, several studies have described disparities in the use of LDCT screening in underserved populations, including racial/ethnic minorities (11,12), those living in rural areas with more limited access to care (13), and other vulnerable populations (14,15). Efforts to understand disparities in LDCT screening and their contributing factors have become increasingly relevant, as previous studies have shown that these same underserved populations have a greater incidence of lung cancer and are less likely to receive appropriate treatment (16)(17)(18)(19).…”

Section: Review Articlementioning

confidence: 99%

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A narrative review of lung cancer screening in underserved populations

Toubat¹,

David²

2021

Curr Chall Thorac Surg

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Lung cancer screening with low-dose computed tomography (LDCT) is an effective approach for the early detection of lung cancer and the reduction of lung cancer specific mortality in high risk individuals. Despite recommendations for LDCT screening by the National Comprehensive Cancer Network (NCCN) and the United States Preventive Services Task Force, the utilization of LDCT screening in clinical practice has been low. Moreover, significant disparities in the use of LDCT have been described in underserved populations, including African American or black patients, rural patients with limited access to LDCT screening facilities, and other vulnerable patient groups with known risk factors for developing lung cancer. Several patient, provider, and healthcare systems level approaches have been proposed to mitigate lung cancer screening disparities. Such approaches include raising awareness of LDCT screening benefits and the evidence in support of LDCT screening among healthcare providers, educating patients on LDCT screening and optimizing shared decision-making approaches between patients and providers, and expanding patient access to LDCT screening through free and mobile lung cancer screening programs. As lung cancer screening utilization continues to expand in clinical practice, it will be critical to continue investigating the trends, causes, and outcomes of LDCT screening disparities in underserved populations.

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Section: Race/ethnicitysupporting

confidence: 59%

Section: Review Articlementioning

confidence: 99%

A narrative review of lung cancer screening in underserved populations

Toubat¹,

David²

2021

Curr Chall Thorac Surg

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“…Detailed study characteristics are provided in Table 3. 12,[40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] The 21 eligible studies were evaluated, and their findings were categorized into 3 overarching themes related to steps in the LCS pipeline in which racial and socioeconomic disparities are known or are likely to exist (Table 4). 12,[40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] The disparities at each step in the pipeline negatively impact outcomes and ultimately result in disparate mortality rates (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Unfortunately, even if high-risk Black individuals and individuals of lower socioeconomic position are eligible for LCS, they are still less likely to obtain the screening. 43,50,58 It is possible that a lack of knowledge among patients and their providers may affect these lower rates. 50 Raz et al found that 80% of LCS eligible smokers had never heard of LCS and that a significant proportion of smokers expressed shame and stigma as being important barriers to screening.…”

Section: Utilization Perception and Utilitymentioning

confidence: 99%

Racial and socioeconomic disparities in lung cancer screening in the United States: A systematic review

Sosa

D'Souza

Akhtar

et al. 2021

CA A Cancer J Clinicians

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Nonsmall cell lung cancer (NSCLC) is the leading cause of cancer deaths. Lung cancer screening (LCS) reduces NSCLC mortality; however, a lack of diversity in LCS studies may limit the generalizability of the results to marginalized groups who face higher risk for and worse outcomes from NSCLC. Identifying sources of inequity in the LCS pipeline is essential to reduce disparities in NSCLC outcomes. The authors searched 3 major databases for studies published from January 1, 2010 to February 27, 2020 that met the following criteria: 1) included screenees between ages 45 and 80 years who were current or former smokers, 2) written in English, 3) conducted in the United States, and 4) discussed socioeconomic and race-based LCS outcomes. Eligible studies were assessed for risk of bias. Of 3721 studies screened, 21 were eligible. Eligible studies were evaluated, and their findings were categorized into 3 themes related to LCS disparities faced by Black and socioeconomically disadvantaged individuals: 1) eligibility; 2) utilization, perception, and utility; and 3) postscreening behavior and care. Disparities in LCS exist along racial and socioeconomic lines. There are several steps along the LCS pipeline in which Black and socioeconomically disadvantaged individuals miss the potential benefits of LCS, resulting in increased mortality. This study identified potential sources of inequity that require further investigation. The authors recommend the implementation of prospective trials that evaluate eligibility criteria for underserved groups and the creation of interventions focused on improving utilization and follow-up care to decrease LCS disparities.

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“…LCS has been underused nationally, with recent evidence indicating that few eligible individuals who smoke are being screened and indicating marked variations in rates of LCS based on race, income, and geographic location ( 24 – 27 ). A recent study at a safety-net institution reported an overall estimated screening rate of 16%; eligible unscreened individuals were more likely to be African American and of lower annual household income ( 27 ). Low screening rates reflect multiple barriers at the patient, provider, and healthcare-system levels ( 28 ).…”

Section: Introductionmentioning

confidence: 99%

Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement

Rivera¹,

Katki²,

Tanner³

et al. 2020

Am J Respir Crit Care Med

159

143

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Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure. Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination. Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS. Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS. Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.

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Age, Race, and Income Are Associated With Lower Screening Rates at a Safety Net Hospital

Cited by 40 publications

References 23 publications

A narrative review of lung cancer screening in underserved populations

A narrative review of lung cancer screening in underserved populations

Racial and socioeconomic disparities in lung cancer screening in the United States: A systematic review

Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement

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