American Cancer Society, Atlanta, GA.
American Cancer Society, Atlanta, GA.
Chest. 2021 Feb;159(2):833-844. doi: 10.1016/j.chest.2020.08.2081. Epub 2020 Sep 1.
Screening current and former heavy smokers 55 to 80 years of age for lung cancer (LC) with low-dose chest CT scanning has been recommended by the United States Preventive Services Task Force since 2013. Although the number of screening facilities in the United States has increased, screening uptake has been slow.
To what extent is geographic access to screening facilities a barrier for screening uptake nationally?
Screening facilities were defined as American College of Radiology (ACR) Lung Cancer Screening Registry (LCSR) facilities. Analysis was performed at different geographic levels using a road network to calculate travel distances for the recommended age groups. Full access to screening was defined as the entire 55- to 79-year-old population being within 40 miles of an ACR LCSR facility. No access was defined as lack of access by the entire target population. Partial access was expressed in intervening quartiles. A geospatial approach then was used to integrate accessibility with smoking prevalence and LC mortality rates to identify potential focus areas visually.
Screening facilities addresses were geocoded to identify 3,592 unique locations. Analysis of census tracts and aggregation to counties revealed that among 3,142 counties, adults 55 to 79 years of age have full access to an LC screening registry facility in 1,988 (63%) counties, partial access in 587 (19%) counties, and no access in 567 (18%) counties. Overall, less than 6% of those 55 to 79 years of age do not have access to registry screening facilities. Variation in screening facility access was noted across the United States, between states, and within some states.
It is recommended to calculate accessibility using subcounty geographies and to examine variation regionally and within states. A foundation geographic accessibility layer can be integrated with other variables to identify geographic disparities in access to screening and to focus on areas for interventions. Identifying areas of greatest need can inform state and local officials and healthcare organizations when planning and implementing LC screening programs.
自 2013 年以来，美国预防服务工作组建议对 55 至 80 岁的当前和既往重度吸烟者进行低剂量胸部 CT 扫描肺癌（LC）筛查。尽管美国的筛查设施数量有所增加，但筛查参与率一直较低。
地理上获得筛查设施在多大程度上成为全国范围内筛查参与的障碍？
筛查设施被定义为美国放射学院（ACR）肺癌筛查登记处（LCSR）设施。使用道路网络在不同的地理层面上进行分析，以计算推荐年龄组的旅行距离。完全获得筛查的定义是整个 55 至 79 岁人群距离 ACR LCSR 设施在 40 英里以内。无接入定义为整个目标人群无法接入。部分接入用四分位数表示。然后使用地理空间方法将可达性与吸烟流行率和 LC 死亡率结合起来，直观地确定潜在的重点区域。
将筛查设施的地址进行地理编码，以确定 3592 个唯一位置。对普查区进行分析并汇总到县，结果显示在 3142 个县中，55 至 79 岁的成年人在 1988 个（63%）县有完全接入 LC 筛查登记处的权限，在 587 个（19%）县有部分接入权限，在 567 个（18%）县没有接入权限。总体而言，不到 6%的 55 至 79 岁的人无法获得登记筛查设施。全美各地、各州之间以及一些州内都存在筛查设施获取情况的差异。
建议使用次县地理区域计算可达性，并在区域和州内检查差异。可以将基本地理可达性图层与其他变量结合使用，以确定筛查获取方面的地理差异，并将重点放在干预措施的区域上。确定最需要的区域可以为州和地方官员以及医疗保健组织在规划和实施 LC 筛查项目时提供信息。
