Kunitomo Yukiko, Bade Brett, Gunderson Craig G, Akgün Kathleen M, Brackett Alexandria, Cain Hilary, Tanoue Lynn, Bastian Lori A
Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT; Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT; Yale School of Medicine, New Haven, CT.
Harvey Cushing/John Hay Whitney Medical Library, Yale School of Medicine, New Haven, CT.
Chest. 2022 Jan;161(1):266-275. doi: 10.1016/j.chest.2021.07.2172. Epub 2021 Aug 12.
In 2013, the United States Preventive Services Taskforce instituted recommendations for annual lung cancer screening (LCS) with low-dose chest CT imaging for high-risk individuals. LCS reduces lung cancer mortality, with greater reduction observed in Black participants in clinical trials. Although racial disparities in lung cancer mortality have been well documented, less is known about disparities in LCS participation and adherence to follow-up in clinical practice.
What is the association between race and adherence to LCS follow-up?
A systematic review was conducted through a search of published studies in MEDLINE, PubMed, EMBASE, Web of Science, and Cumulative Index to Nursing and Allied Health Literature Database from database inception through October 2020. We included studies that examined rates of adherence to LCS follow-up and compared rates by race. Studies were pooled using random-effects meta-analysis.
We screened 18,300 titles and abstracts, and 229 studies were selected for full-text review. Nine studies met inclusion criteria; seven were included in the meta-analysis. Median adherent follow-up rate was 37% (range, 16%-82%). Notable differences among the studies included the proportion of the Black population (range, 4%-47%) and the structure of the LCS programs. The meta-analyses showed lower adherence to LCS follow-up in the Black population (OR, 0.67; 95% CI, 0.55-0.80). This disparity persisted across all malignancy risk levels determined by initial screening results.
Lower adherence to LCS follow-up in Black compared with White patients occurs despite the higher potential lung cancer mortality benefit. Literature specifically addressing race-related barriers to LCS adherence remains limited. To ensure equity in LCS benefits, greater outreach to eligible Black patients should be implemented through increased physician education and use of screening program coordinators to focus on this patient population.
PROSPERO; No.: CRD42020214213; URL: http://www.crd.york.ac.uk/PROSPERO.
2013年，美国预防服务工作组针对高危个体制定了每年进行低剂量胸部CT成像肺癌筛查（LCS）的建议。LCS可降低肺癌死亡率，在临床试验中，黑人参与者的死亡率降低幅度更大。尽管肺癌死亡率的种族差异已有充分记录，但对于临床实践中LCS参与率和后续随访依从性的差异了解较少。
种族与LCS后续随访依从性之间有何关联？
通过检索MEDLINE、PubMed、EMBASE、科学网和护理及联合健康文献累积索引数据库中从建库至2020年10月发表的研究进行系统评价。我们纳入了检查LCS后续随访依从率并按种族比较率的研究。采用随机效应荟萃分析对研究进行汇总。
我们筛选了18300个标题和摘要，选择了229项研究进行全文审查。9项研究符合纳入标准；7项纳入荟萃分析。中位依从性随访率为37%（范围为16%-82%）。研究之间的显著差异包括黑人人口比例（范围为4%-47%）和LCS项目结构。荟萃分析显示黑人人群对LCS后续随访的依从性较低（OR，0.67；95%CI，0.55-0.80）。这种差异在根据初始筛查结果确定的所有恶性肿瘤风险水平中均持续存在。
尽管肺癌死亡率潜在获益更高，但黑人患者与白人患者相比，对LCS后续随访的依从性较低。专门探讨与种族相关的LCS依从性障碍的文献仍然有限。为确保LCS益处的公平性，应通过加强医生教育和利用筛查项目协调员关注这一患者群体，对符合条件的黑人患者进行更多宣传。
PROSPERO；编号：CRD42020214213；网址：http://www.crd.york.ac.uk/PROSPERO 。
