Department of Health Systems Management, Rush University, Chicago, IL, United States.
Department of Population Health Nursing Science, The University of Illinois at Chicago, Chicago, IL, United States.
Front Public Health. 2021 Aug 25;9:684558. doi: 10.3389/fpubh.2021.684558. eCollection 2021.
The purpose of this study was to examine the influence of access to care on the uptake of low-dose computed tomography (LDCT) lung cancer screening among a diverse sample of screening-eligible patients. We utilized a cross-sectional study design. Our sample included patients evaluated for lung cancer screening at a large academic medical center (AMC) between 2015 and 2017 who met 2013 USPSTF guidelines for LDCT screening eligibility. The completion of LDCT screening (yes, no) was the primary dependent variable. The independent variable was access to care (insurance type, living within the AMC service area). We utilized binary logistic regression analyses to examine the influence of access to care on screening completion after adjusting for demographic factors (age, sex, race) and smoking history (current smoking status, smoking pack-year history). A total of 1,355 individuals met LDCT eligibility criteria, and of those, 29.8% ( = 404) completed screening. Regression analysis results showed individuals with Medicaid insurance (OR, 1.51; 95% CI, 1.03-2.22), individuals living within the AMC service area (OR, 1.71; 95% CI, 1.21-2.40), and those aged 65-74 years (OR, 1.49; 95% CI, 1.12-1.98) had higher odds of receiving LDCT lung cancer screening. Lower odds of screening were associated with having Medicare insurance (OR, 0.30; 95% CI, 0.22-0.41) and out-of-pocket (OR, 0.27; 95% CI, 0.15-0.47). Access to care was independently associated with lowered screening rates. Study results are consistent with prior research identifying the importance of access factors on uptake of cancer early detection screening behaviors.
本研究旨在探讨可及性对符合条件的筛查患者中接受低剂量计算机断层扫描（LDCT）肺癌筛查的影响。我们采用了横断面研究设计。我们的样本包括 2015 年至 2017 年间在一家大型学术医疗中心（AMC）接受肺癌筛查评估的患者，他们符合 2013 年 USPSTF 关于 LDCT 筛查资格的标准。LDCT 筛查的完成（是，否）是主要的因变量。自变量是可及性（保险类型，居住在 AMC 服务区域内）。我们利用二元逻辑回归分析，在调整了人口统计学因素（年龄、性别、种族）和吸烟史（当前吸烟状况、吸烟包年史）后，研究了可及性对筛查完成的影响。共有 1355 名个体符合 LDCT 资格标准，其中 29.8%（=404）完成了筛查。回归分析结果显示，拥有医疗补助保险的个体（OR，1.51；95%CI，1.03-2.22）、居住在 AMC 服务区域内的个体（OR，1.71；95%CI，1.21-2.40）和年龄在 65-74 岁的个体（OR，1.49；95%CI，1.12-1.98）接受 LDCT 肺癌筛查的可能性更高。筛查可能性较低与拥有医疗保险（OR，0.30；95%CI，0.22-0.41）和自付费用（OR，0.27；95%CI，0.15-0.47）有关。可及性与较低的筛查率独立相关。研究结果与先前研究一致，这些研究确定了获得因素对癌症早期检测筛查行为的重要性。
