Association of Socioeconomic Status with Adherence to Annual Lung Cancer Screening

Document Type

Conference Proceeding

Publication Date

5-17-2022

Publication Title

Am J Respir Crit Care Med

Abstract

RATIONALE: Among adults undergoing lung cancer screening (LCS) with low-dose computed tomography (LDCT), adherence to subsequent annual LCS has been recommended as a quality metric for LCS programs. Compared to White patients, Black patients receive annual LCS less frequently, especially at decentralized LCS programs. However, previous studies have not evaluated this racial disparity by different levels of socioeconomic status (SES). Thus, we aimed to determine adherence to annual LCS stratified by race and the Yost index-a validated neighborhood-level SES measure-among individuals receiving a baseline LDCT for LCS. METHODS: We performed a multicenter retrospective cohort study of patients aged 55-75 years who had a negative (Lung-RADS 1 or 2) baseline LDCT between January 1, 2015, and September 30, 2017, at five healthcare systems within the Population-based Research to Optimize the Screening Process (PROSPR)-Lung Consortium. The primary outcome was adherence to annual LCS, defined as a repeat LDCT or chest CT 11-15 months after baseline screening. We used the Cochran-Armitage test to assess for linear trends in adherence across Yost index quintiles assigned to each patient using geocoded census-tract data (1-5; higher quintiles represent higher SES levels), stratified by patient race (White, Black) and type of LCS program (decentralized, centralized). We calculated estimates of adherence adjusted for age, sex, smoking status, body mass index, Charlson comorbidity index, and year of baseline screen using modified Poisson regression with mixed effects to account for site variability. RESULTS: Of the 5,142 patients (median age 65 years [IQR 60-69]), 2,747 were screened at decentralized LCS programs (70% White, 23% Black) and 2,395 at centralized programs (71% White, 4% Black), respectively. At decentralized programs, adherence to annual LCS increased linearly with increasing SES among Black patients (range: 16- 47%; P=0.003) but not White patients (range: 30-40%; P=0.566). In contrast at centralized programs, a linear trend in adherence by SES was not observed in either Black (range: 63-80%; P=0.450) or White patients (range: 67-80%; P=0.055). The Figure displays multivariable adjusted estimates of adherence by SES at decentralized and centralized sites stratified by patient race. CONCLUSIONS: At decentralized LCS programs, lower SES levels were associated with reduced annual LCS rates among Black compared to White patients. In contrast, at centralized programs there was no significant association between SES and LCS adherence among either Black or White patients. Further research investigating mediators of racial disparities is necessary to ensure quality care is delivered to all patients recommended for LCS.

Volume

205

Issue

1

First Page

A4821

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