Disparities in Lung Cancer Screening Utilization at Two Health Systems in the Southeastern US

ABSTRACT Purpose Low-dose computed tomography lung cancer screening is effective for reducing lung cancer mortality. It is critical to understand the lung cancer screening practices for screen-eligible individuals living in Alabama and Georgia where lung cancer is the leading cause of cancer death. High lung cancer incidence and mortality rates are attributed to high smoking rates among underserved, low income, and rural populations. Therefore, the purpose of this study: (1) to define sociodemographic and clinical characteristics of patients who were screened for lung cancer at an Academic Medical Center (AMC) in Alabama and a Safety Net Hospital (SNH) in Georgia. Methods A retrospective cohort study of patient electronic health records who received lung cancer screening between 2015 to 2020 was performed to identify the study population and outcome variable measures. Chi-square tests and Student t-tests were used to compare screening uptake across patient demographic and clinical variables. Bivariate and multivariate logistic regressions determined significant predictors of lung cancer screening uptake. Results At the AMC, 67,355 were identified as eligible for LCS and 1,129 were screened. In bivariate analyses, there were several differences between those who were screened and those who were not screened. Screening status in the site at Alabama varied significantly by age (P<0.01), race (P<0.001), marital status (P<0.01), smoking status (P<0.01) health insurance (P<0.01), median income (P<0.01), urban status (P<0.01) and distance from UAB (P<0.01). Those who were screened were more likely to have lesser comorbidities (2.31 vs. 2.53; P<0.001). At the SNH, 11,011 individuals were identified as screen-eligible and 500 were screened. In the site at Georgia, screening status varied significantly by race (P<0.01), health insurance (P<0.01), and distance from site (P<0.01). At the AMC, the odds of being screened increased significantly if the individual was a current smoker compared to former smoker (OR=3.21; P<0.01). At the SNH, the odds of being screened for lung cancer increased significantly with every unit increase in co-morbidity count (OR = 1.12; P=0.01) Conclusion The study provides evidence that LCS has not reached all subgroups and that additional targeted efforts are needed to increase lung cancer screening uptake. Furthermore disparity was noticed between adults living closer to screening institutions and those who lived farther.