Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
J Rural Health. 2022 Jan;38(1):40-53. doi: 10.1111/jrh.12568. Epub 2021 Mar 18.
The US Preventive Services Task Force recommends lung cancer screening with Low-Dose Computed Tomography (LDCT) in high-risk individuals. Our objective was to identify demographic, health, and financial factors associated with screening uptake, with a focus on urban-rural differences.
We analyzed data from the 2018 and 2019 Behavioral Risk Factor Surveillance System and its optional Lung Cancer Screening Module to examine factors associated with screening uptake among 20 states that administered the optional module. We compared differences in factors associated with uptake overall and by geographical regions and conducted multivariable logistic mixed-effects regression, accounting for participant clustering by state to assess the impact of these factors on uptake.
Overall 1,268 participants underwent LDCT screening with no significant differences observed between rural (16.3%) and urban residents (17.7%, p = 0.67). In multivariable models, rural residents did not differ significantly in their LDCT screening uptake (OR = 0.85; 95% CI: 0.67-1.09, p = 0.20), but uptake was significantly higher for participants with underlying chronic respiratory conditions, veterans, those with higher pack-year history, and those with poor/fair general health and prior history of cancer. Uptake declined with age, higher education level, concerns about paying for medical care, and lack of primary care.
Modifiable targets can be leveraged to increase LDCT screening. Based on significant predictors of screening uptake, clinicians should prioritize interventions that effectively consider smoking history as well as those identified as effective in veterans' health settings. Additionally, reducing structural barriers to care related to insurance and income will be key to reducing disparities.
美国预防服务工作组建议对高危人群进行低剂量计算机断层扫描（LDCT）肺癌筛查。我们的目的是确定与筛查参与相关的人口统计学、健康和财务因素，重点关注城乡差异。
我们分析了 2018 年和 2019 年行为风险因素监测系统及其可选的肺癌筛查模块的数据，以检查在实施可选模块的 20 个州中与筛查参与相关的因素。我们比较了总体以及按地理区域划分的与参与相关的因素差异，并进行了多变量逻辑混合效应回归，考虑了按州划分的参与者聚类，以评估这些因素对参与的影响。
总体而言，有 1268 名参与者接受了 LDCT 筛查，农村居民（16.3%）和城市居民（17.7%）之间没有显著差异（p=0.67）。在多变量模型中，农村居民的 LDCT 筛查参与率没有显著差异（OR=0.85；95%CI：0.67-1.09，p=0.20），但有潜在慢性呼吸系统疾病、退伍军人、吸烟史较高、一般健康状况较差/一般以及有癌症病史的参与者的筛查参与率显著较高。随着年龄的增长、教育水平的提高、对支付医疗费用的担忧以及缺乏初级保健，参与率会下降。
可以利用可修改的目标来增加 LDCT 筛查。根据筛查参与的显著预测因素，临床医生应优先考虑那些有效考虑吸烟史的干预措施，以及那些在退伍军人健康环境中被证明有效的干预措施。此外，减少与保险和收入相关的护理结构障碍将是缩小差距的关键。
