Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York.
Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York-Presbyterian Hospital, New York.
JAMA Netw Open. 2022 Sep 1;5(9):e2229741. doi: 10.1001/jamanetworkopen.2022.29741.
Lung cancer incidence and mortality have disproportionate consequences for racial and ethnic minority populations. The extent to which the 2021 changes to the US Preventive Services Task Force (USPSTF) screening guidelines have reduced the racial disparity gap in lung cancer screening eligibility is not known.
To assess the consequences of the changes in USPSTF low-dose computed tomography eligibility criteria for lung cancer screening between 2013 and 2021 among Black and White community-dwelling adults.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data from the Reasons for Geographic and Racial Differences in Stroke study, a prospective longitudinal cohort study of community-dwelling Black and White adults 45 years and older who were initially recruited across the US between January 2003 and October 2007, with ongoing follow-up. All participants who would have been potentially eligible for lung cancer screening based on the 2021 USPSTF guidelines (N = 14 285) were included. Follow-up data for the current cohort study were collected and analyzed between January 2013 and December 2017, with final analysis performed in 2021.
Self-reported Black vs White race.
Differences in the proportion of Black vs White participants eligible for lung cancer screening according to 2013 and 2021 guidelines were assessed using modified Poisson models with robust SEs. Associations between important covariates (demographic characteristics and social factors associated with health), including interaction and dissimilarity indices (2 measures of residential segregation), and differences in screening eligibility were also examined.
Among 14 285 participants (mean [SD] age, 64.7 [7.5] years; 7675 men [53.7%]), 5787 (40.5%) self-identified as Black and 8498 (59.5%) as White. Based on the 2013 USPSTF guidelines, 1109 of 5787 Black participants (19.2%) and 2313 of 8498 White participants (27.2%) were eligible for lung cancer screening (difference, -8.06 percentage points; 95% CI, -9.44 to -6.67 percentage points). Based on the 2021 guidelines, 1667 of 5787 Black participants (28.8%) and 2940 of 8498 White participants (34.6%) were eligible for screening (difference, -5.73 percentage points; 95% CI, -7.28 to -4.19 percentage points). After adjustment for differences in individual characteristics and residential segregation, the 2013 difference in screening eligibility among Black vs White participants was -12.66 percentage points (95% CI, -14.71 to -10.61 percentage points), and the 2021 difference was -12.15 percentage points (95% CI, -14.37 to -9.93 percentage points).
In this study, 2021 changes to the USPSTF lung cancer screening guidelines were associated with reductions in but not elimination of existing eligibility disparities in lung cancer screening among Black and White adults. These findings suggest that accounting for factors beyond age and pack-years of smoking is needed when tailoring guidelines to improve screening eligibility among groups at high risk of lung cancer.
肺癌的发病率和死亡率对少数族裔和族裔群体造成了不成比例的后果。尚不清楚美国预防服务工作组（USPSTF）筛查指南 2021 年的变化在多大程度上减少了肺癌筛查资格方面的种族差异。
评估 2013 年至 2021 年间 USPSTF 低剂量计算机断层扫描（CT）肺癌筛查资格标准变化对黑人和白人社区居住成年人的影响。
设计、地点和参与者：这项队列研究分析了 Reasons for Geographic and Racial Differences in Stroke 研究的数据，这是一项针对社区居住的 45 岁及以上黑人和白人成年人的前瞻性纵向队列研究，最初在美国各地招募，招募时间为 2003 年 1 月至 2007 年 10 月，随访时间持续进行。所有符合 2021 年 USPSTF 指南潜在肺癌筛查资格的参与者（N=14285）均被纳入本研究。本队列研究的随访数据于 2013 年 1 月至 2017 年 12 月间收集和分析，最终分析于 2021 年进行。
自我报告的黑人和白人种族。
采用改良泊松模型和稳健标准误评估了 2013 年和 2021 年指南中黑人和白人参与者的肺癌筛查资格比例差异。还检查了重要协变量（与健康相关的人口统计学特征和社会因素）之间的关联，包括交互和差异指数（2 种居住隔离测量），以及筛查资格差异。
在 14285 名参与者中（平均[标准差]年龄为 64.7[7.5]岁；男性 7675 人[53.7%]），5787 人（40.5%）自我认定为黑人，8498 人（59.5%）为白人。根据 2013 年 USPSTF 指南，5787 名黑人参与者中有 1109 名（19.2%）和 8498 名白人参与者中有 2313 名（27.2%）符合肺癌筛查资格（差异，-8.06 个百分点；95%CI，-9.44 至-6.67 个百分点）。根据 2021 年指南，5787 名黑人参与者中有 1667 名（28.8%）和 8498 名白人参与者中有 2940 名（34.6%）符合筛查资格（差异，-5.73 个百分点；95%CI，-7.28 至-4.19 个百分点）。在调整了个体特征和居住隔离的差异后，黑人参与者与白人参与者之间 2013 年筛查资格的差异为-12.66 个百分点（95%CI，-14.71 至-10.61 个百分点），2021 年的差异为-12.15 个百分点（95%CI，-14.37 至-9.93 个百分点）。
在这项研究中，USPSTF 肺癌筛查指南的 2021 年修订与黑人和白人成年人肺癌筛查资格方面现有差异的缩小有关，但并没有消除这些差异。这些发现表明，在为高风险肺癌群体定制指南以提高筛查资格时，需要考虑年龄和吸烟包年数以外的因素。
