Demographic factors limit access to CT lung screening

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Smokers who are older, uninsured, undereducated, and live in a rural area are more likely to be located farther away from a CT lung cancer screening facility and thus have limited access to screening services, according to an article published online July 11 in the Journal of the American College of Radiology.

The researchers analyzed the geographic distribution and demographics of smokers recorded in the U.S. Census Bureau population estimates of 2012 to 2016 for all 73,057 census tracts in the country. In a prior study examining these data, they reported that individuals who lived in densely populated regions -- i.e., urban areas -- were situated significantly closer to accredited CT lung screening facilities than those who lived in rural areas.

Expanding upon this earlier work, first author Dr. Tina Tailor and colleagues from Duke University set out to determine the extent to which other sociodemographic factors may be linked to decreased access to screening facilities. Their underlying motivation was that this knowledge could inform practices and policies aimed at improving uptake of the exam, especially for underserved populations.

"Efforts to appropriately implement [CT lung screening] in populations of highest need is critical to reducing lung cancer mortality," the authors wrote. "In this regard, the successful implementation of [CT lung screening] calls upon the knowledge of patient- and provider-level barriers to facilitate targeted interventions that promote uptake among all eligible populations."

Even after controlling for the sociodemographic makeup of the population, the researchers' secondary analysis still confirmed the findings of their initial study -- that individuals living in sparsely populated areas were located much farther away from screening facilities than those living in urban areas (p < 0.001).

The analysis additionally revealed that individuals who resided in regions with a greater proportion of people who were older, had less than a high school degree, and who did not have insurance or were enrolled in Medicaid were also more likely to be located farther away from a CT lung screening facility (p < 0.001).

Effect of sociodemographic factors on access to CT lung cancer screening
  Proportional increase in distance away from a screening facility per percentage increase in people meeting the demographic factor
Rural resident 0.86
Older age 0.15
Covered by Medicaid 0.10
Less than a high school degree 0.07
Not insured 0.04
The changes were statistically significant (p < 0.001).

Conversely, regions that were predominantly African American, Hispanic, and female, as well as regions with a higher-than-median income, tended to be located closer to a screening facility (p < 0.001). This pattern underscores some of the potential racial disparities cited in recent studies affirming that African Americans and Hispanics are usually less likely to participate in CT lung screening despite being at greater risk of developing lung cancer.

In effect, racial minorities do not appear to be participating in lung screening despite being located closer to facilities, suggesting that distance may not be a major factor for this cohort, the authors noted.

Further research is needed to better grasp the key contributors to CT lung screening access and uptake, which will be "fundamental to implementing a widespread screening program that meets the goal of reducing lung cancer mortality in all high-risk populations," Tailor and colleagues concluded.

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