Age, Race, and Income Are Associated With Lower Screening Rates at a Safety Net Hospital

Ann Thorac Surg. 2020 May;109(5):1544-1550. doi: 10.1016/j.athoracsur.2019.11.052. Epub 2020 Jan 22.

Abstract

Background: While lung cancer screening improves cancer-specific mortality and is recommended for high-risk patients, barriers to screening still exist. We sought to determine our institution's (an urban safety net hospital) screening rate and to identify socioeconomic barriers to lung cancer screening.

Methods: We identified 8935 smokers 55 to 80 years of age evaluated by a primary care physician between March 2015 and March 2017 at our institution. We randomly selected one-third of these (n = 2978) to review for eligibility using the U.S. Preventive Services Task Force criteria for lung cancer screening. Using our institution's Lung Cancer Screening Program clinical tracking database, we identified patients who were screened from March 2015 to March 2017. We collected demographic information (race, primary language, education status, and median income) and evaluated possible associations with screening.

Results: Among our institution population, 99 patients meeting U.S. Preventive Services Task Force screening criteria underwent screening computed tomography, whereas 516 eligible patients were not screened, making our institution's estimated screening rate 16.1%. Comparing the unscreened population with those who received screening at our institution, the unscreened population was significantly older (median age of screened patients was 63 years, of unscreened patients was 66 years; P < .001). African Americans had a lower screening rate (37.6% of the screened population and 47.5% of the unscreened population; P < .001). Unscreened patients had a lower annual household income.

Conclusions: The lung cancer screening rate at our hospital is 16.1%. Unscreened patients were older, were more likely to be African American, and had a lower median income. These findings highlight possible screening barriers and potential areas for targeted strategies to decrease disparities in lung cancer screening.

MeSH terms

  • Age Factors
  • Aged
  • Early Detection of Cancer / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Lung Neoplasms / diagnosis*
  • Lung Neoplasms / economics
  • Lung Neoplasms / ethnology
  • Male
  • Mass Screening / statistics & numerical data*
  • Middle Aged
  • Morbidity / trends
  • Racial Groups*
  • Retrospective Studies
  • Safety-net Providers / statistics & numerical data*
  • Socioeconomic Factors
  • Tomography, X-Ray Computed / methods
  • United States / epidemiology