Division of Pulmonary, Allergy, Sleep and Critical Care Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts; Division of Computational Biomedicine Medicine, Boston University School of Medicine, Boston, Massachusetts.
Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.
Ann Thorac Surg. 2020 May;109(5):1544-1550. doi: 10.1016/j.athoracsur.2019.11.052. Epub 2020 Jan 22.
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.
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.
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.
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.
虽然肺癌筛查可提高癌症特异性死亡率，且被推荐用于高危患者，但筛查仍存在障碍。我们旨在确定本机构（一家城市医疗保障医院）的筛查率，并确定肺癌筛查的社会经济障碍。
我们在本机构鉴定了 8935 名年龄在 55 岁至 80 岁之间的吸烟者，这些患者均由初级保健医生在 2015 年 3 月至 2017 年 3 月间进行评估。我们随机选择其中的三分之一（n=2978），并使用美国预防服务工作组（USPSTF）的肺癌筛查标准进行筛查资格审查。利用本机构的肺癌筛查计划临床跟踪数据库，我们确定了在 2015 年 3 月至 2017 年 3 月间进行筛查的患者。我们收集了人口统计学信息（种族、主要语言、教育程度和中位数收入），并评估了与筛查相关的可能关联。
在本机构人群中，有 99 名符合 USPSTF 筛查标准的患者接受了筛查 CT，而有 516 名符合条件的患者未进行筛查，本机构的估计筛查率为 16.1%。与接受本机构筛查的人群相比，未筛查人群的年龄明显更大（筛查患者的中位年龄为 63 岁，未筛查患者的中位年龄为 66 岁；P<0.001）。非裔美国人的筛查率较低（筛查人群中有 37.6%为非裔美国人，未筛查人群中有 47.5%为非裔美国人；P<0.001）。未筛查患者的家庭年收入较低。
本医院的肺癌筛查率为 16.1%。未筛查患者的年龄较大，更可能为非裔美国人，且中位数收入较低。这些发现突显了可能的筛查障碍和潜在的目标策略领域，以减少肺癌筛查中的差异。
