Department of Radiology, Duke University Medical Center, Durham, North Carolina.
Department of Surgery, Duke University Medical Center, Durham, North Carolina.
N C Med J. 2021 Sep-Oct;82(5):321-326. doi: 10.18043/ncm.82.5.321.
Low-dose chest CT (LDCT) is the only effective screening test for lung cancer. Annual lung cancer screening (LCS) is recommended by the US Preventive Services Task Force (USPSTF) for individuals at high risk for primary lung neoplasm. We retrospectively identified patients receiving LCS from January 2016 through March 2018 whose residential addresses were within our health center's county. We estimated driving distance from the patient's address to our health center and obtained sociodemographic characteristics from the electronic health record (EHR). The census-tract-level LCS-eligible population size was estimated, and their population characteristics determined via US Census Bureau, Centers for Disease Control and Prevention (CDC), and Behavioral Risk Factor Surveillance System (BRFSS) data. The Cochran-Mantel-Haenszel test was used to determine differences amongst the LCS-eligible and LCS-enrolled populations. Multivariable regression was used to determine the effects of sociodemographic characteristics on LCS eligibility. There was modest correlation between census-tract-level LCS-eligible population size and LCS enrollment ( = 0.68, < .001). 5.9% (364/6185) of the estimated LCS-eligible population in our county received LCS, with census-tract LCS rates ranging from 1.5% to 12.5%. Nonwhite race status (Hispanic and African American) was associated with decreased likelihood of LCS enrollment compared to White race (OR = 95% CI, 0.765 [0.61, 0.95] and 0.031 [0.008, 0.124], respectively). Older age, Medicaid, and uninsured statuses were positively correlated with LCS eligibility ( ≤ .01). This analysis comprises a single county. Other LCS facilities within our health system in neighboring counties, as well as individuals receiving LCS outside of our health system, are not captured. The uptake of LCS remains low, with disproportionately lower screening rates amongst Hispanic and African American populations. Medicaid and uninsured patients in our community are also more likely to be LCS-eligible. These populations may be targets for interventions aimed at increasing LCS awareness and uptake.
低剂量胸部 CT（LDCT）是肺癌唯一有效的筛查试验。美国预防服务工作组（USPSTF）建议对原发性肺肿瘤高危人群进行年度肺癌筛查（LCS）。我们回顾性地确定了 2016 年 1 月至 2018 年 3 月期间在我们的健康中心所在县居住的接受 LCS 的患者。我们估计了从患者地址到我们健康中心的驾驶距离，并从电子健康记录（EHR）中获取了社会人口统计学特征。通过美国人口普查局、疾病控制与预防中心（CDC）和行为风险因素监测系统（BRFSS）数据估计了符合 LCS 的普查区人口规模，并确定了其人口特征。使用 Cochran-Mantel-Haenszel 检验来确定符合 LCS 条件的人群和登记参加 LCS 的人群之间的差异。多变量回归用于确定社会人口统计学特征对 LCS 资格的影响。普查区符合 LCS 条件的人口规模与 LCS 登记之间存在适度相关性（ = 0.68， <.001）。在我们县，估计有 5.9%（364/6185）的符合 LCS 条件的人口接受了 LCS，普查区的 LCS 率从 1.5%到 12.5%不等。与白人种族相比，非白种人种族（西班牙裔和非裔美国人）的 LCS 登记率较低（OR=95%CI，0.765[0.61,0.95]和 0.031[0.008,0.124]）。年龄较大、医疗补助和无保险状态与 LCS 资格呈正相关（ ≤.01）。这项分析仅包括一个县。我们健康系统中邻近县的其他 LCS 设施以及在我们健康系统外接受 LCS 的个人均未包括在内。LCS 的接受率仍然很低，西班牙裔和非裔美国人的筛查率较低。我们社区中的医疗补助和无保险患者也更有可能符合 LCS 条件。这些人群可能是旨在提高 LCS 意识和接受度的干预措施的目标。
