Understanding factors associated with uptake of lung cancer screening among individuals at higher risk.

Abstract

10559 Background: Lung cancer is the leading cause of cancer death in the U.S, accounting for about 25% of all cancer mortality. The U.S Preventive Services Task Force has recommended annual screening for lung cancer using low-dose computed tomography (LDCT) scanning for individuals at higher risk (aged 55-80 years with a >30 pack-year smoking history). Early detection using LDCT scanning reduces lung cancer specific mortality by 20%. Despite its efficacy, the uptake of annual lung cancer screening among high-risk individuals remains low ( < 18%). The purpose of this study was to identify factors associated with the uptake of lung cancer screening in high-risk individuals in the U.S population. Methods: Data for this study were obtained from the 2017-2019 Behavioral Risk Factor Surveillance System (BRFSS), a population-based survey conducted annually by the Centers for Disease Control and Prevention (CDC) in collaboration with health departments in all 50 states, Washington, DC, and the U.S territories. We restricted our sample to high-risk individuals aged 55-80 years with a >30 pack-year smoking history. Only subjects with complete data on all predictor variables (age, gender, race/ethnicity, marital status, education, income, insurance, COPD, current smoking status, primary care provider) and the outcome variable (uptake of lung cancer screening) (n = 11, 714) were included in the final analysis. Chi-square tests were used to compare the uptake of lung cancer screening by demographic and socioeconomic factors. Multivariable logistic regression models were used to model the association between the predictors and the outcome variable. Results: Individuals with no health insurance (OR: 0.64; 95%CI: 0.46-0.90), no primary healthcare provider (OR: 0.40; 95%CI: 0.31-0.52), no chronic obstructive pulmonary disease (COPD) (OR: 0.35; 95%CI: 0.31-0.0.40) and who were females (OR: 0.86; 95%CI: 0.76-0.96) were less likely to participate in annual lung cancer screening. Individuals aged 65–69 years (OR: 1.65; 95%CI: 1.38-1.97), 70–74 years (OR: 1.77; 95%CI: 1.46-2.14) or 75–80 years (OR: 1.42; 95%CI: 1.16-1.76) were more likely to receive annual lung cancer screening compared with those aged 55-59 years. Race/ethnicity, level of education, level of income, marital status, and current smoking status had no significant association with the uptake of annual lung cancer screening. Conclusions: Our study identifies factors associated with lower uptake of annual lung cancer screening (no health insurance coverage, no primary healthcare provider, no COPD, and female gender). The findings from this study have important implications for the design of more effective interventions to target specific subgroups for the uptake of annual lung cancer screening.

Likelihood of Lung Cancer Screening by Poor Health Status and Race and Ethnicity in US Adults, 2017 to 2020

“…In general, cancer screening tests are associated with socioeconomic status and smoking behavior, 34 which holds true for LCS. 12 Correlates of LCS also include health care access, 23 COPD, prior cancer, 13 , 22 , 35 state of residence, 36 receipt of prior vaccination, 12 demographic characteristics (eg, marital status and employment), and smoking history in pack-years. 12 …”

“…In general, cancer screening tests are associated with socioeconomic status and smoking behavior, 34 which holds true for LCS. 12 Correlates of LCS also include health care access, 23 COPD, prior cancer, 13,22,35 state of residence, 36 receipt of prior vaccination, 12 demographic characteristics (eg, marital status and employment), and smoking history in pack-years. 12 To account for socioeconomic status and demographics, we extracted data on age (in 5-year age categories), sex (male and female), race and ethnicity (aforementioned categories), marital status (married, divorced, widowed, separated, never married, or unmarried couple), and educational attainment (never attended school or only kindergarten, elementary or middle school, some high school, high school graduate, some college, and college graduate or more).…”

“…Racial disparities have been observed in single centers in Rhode Island, 16 Pennsylvania, 17 Indiana, 18 and North Carolina, 19 but population-level analyses have failed to show LCS disparities by race and ethnicity. 13 , 20 , 21 , 22 , 23 However, poor self-rated health and all-cause mortality are still associated with race and ethnicity in the US, 24 , 25 with non-Hispanic Black individuals experiencing a 20% higher all-cause mortality than non-Hispanic White individuals, 26 in large part due to structural racism. 27 If poor health is associated with increased screening, and individuals from historically minoritized racial and ethnic groups are more likely to be in poor health, then racial or ethnic disparities could be obscured unless comparisons account for health status.…”

Factors Associated With Declining Lung Cancer Screening After Discussion With a Clinician in a Cohort of US Veterans

“…We selected clinically relevant covariables a priori based on prior studies of factors related to uptake of or adherence to LCS, including self-reported race and ethnicity to explore potential disparities in declining LCS. 18 , 19 , 20 , 21 , 22 , 23 For each veteran, we extracted data from the VA Corporate Data Warehouse on demographic characteristics and VA priority status (the VA’s system to determine co-payments). We used a veteran’s residential zip code to estimate median income, and we assessed urbanization using the US Census Bureau Rural-Urban Commuting Area codes.…”

“…The primary outcome was documentation (by clinical reminder) that a veteran declined LCS. We selected clinically relevant covariables a priori based on prior studies of factors related to uptake of or adherence to LCS, including self-reported race and ethnicity to explore potential disparities in declining LCS . For each veteran, we extracted data from the VA Corporate Data Warehouse on demographic characteristics and VA priority status (the VA’s system to determine co-payments).…”