Racial Disparities in Annual Lung Cancer Screening Follow-up: An Updated Analysis of a Multicenter Cohort Study
Recommended Citation
Kim RY, Rendle KA, Mitra N, Neslund-Dudas C, Greenlee RT, Burnett-Hartman AN, Honda SA, Simoff MJ, Schapira MM, Croswell JM, Meza R, Ritzwoller DP, Vachani A. Racial Disparities in Annual Lung Cancer Screening Follow-up: An Updated Analysis of a Multicenter Cohort Study. Am J Respir Crit Care Med 2024; 209:A3057.
Document Type
Conference Proceeding
Publication Date
6-1-2024
Publication Title
Am J Respir Crit Care Med
Abstract
RATIONALE: We previously demonstrated that adherence to annual lung cancer screening (LCS) is higher at centralized compared to decentralized programs, with program decentralization associated with racial disparities in adherence. Here we report an updated analysis with a larger sample and additional years of follow-up data to examine racial disparities in LCS follow-up among individuals with negative baseline screens recommended for ongoing annual LCS. METHODS: We performed a multicenter retrospective cohort study of 55-75 year-old patients who formerly or currently smoked and received baseline LCS between 1/1/2015 and 6/30/2019 at healthcare systems within the Population-based Research to Optimize the Screening Process (PROSPR)- Lung Consortium. We restricted our analysis to individuals with negative baseline screens (Lung Imaging Reporting and Data System [Lung-RADS] 1 or 2) and excluded those with a prior lung cancer diagnosis and those who died within 30 months of baseline LCS. Using electronic health record and billing data, we identified all follow-up chest computed tomography (CT) imaging within 30 months of baseline LCS and evaluated the association between LCS program centralization and patient race with annual LCS adherence using descriptive statistics, multivariable modified Poisson regression, and kernel density plots. RESULTS: Of the 10,353 patients with a negative baseline screen (median age: 64 years [IQR: 60-69 years]; median pack-year smoking history: 40 [IQR: 32-52]; median Charlson Comorbidity Index: 1 [IQR: 0-2]), 7,507 (72.5%) identified as White, 1,499 (14.5%) as Black, and 6,063 (58.6%) as currently smoking. Of these individuals, 6,648 (64.2%) were screened at decentralized programs, and 3,705 (35.8%) at centralized programs. At decentralized programs, Black patients, compared to White patients, were less likely to have a follow-up chest CT within 10-15 months of baseline LCS (28.5% vs 40.3%; P<0.001) and more likely to have delayed imaging follow-up within 15-30 months (29.5% vs 23.7%; P<0.001) or no follow-up imaging within 30 months (36.3% vs 30.4%; P<0.001). In contrast, at centralized programs Black individuals had similar follow-up rates compared to White individuals at 10-15 months (67.5% vs 71.5%; P=0.360), 15-30 months (19.3% vs 15.0%; P=0.206), and no follow-up within 30 months (7.9% vs 7.6%; P=0.906; Figure). Multivariable adjusted adherence for Black and White patients were 30.8% vs 38.2% (P<0.001) and 71.1% vs 74.5% (P=0.172) at decentralized and centralized programs, respectively. CONCLUSIONS: This updated multicenter analysis confirms that program centralization is associated with reduced racial disparities in annual LCS adherence and represents a feasible systemic approach to promoting health equity in LCS.
Volume
209
First Page
A3057
