School of Medicine, UT Southwestern Medical Center, Dallas, TX.
Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX.
J Natl Compr Canc Netw. 2024 Apr 26;22(5):308-314. doi: 10.6004/jnccn.2023.7112.
Recent modifications to low-dose CT (LDCT)-based lung cancer screening guidelines increase the number of eligible individuals, particularly among racial and ethnic minorities. Because these populations disproportionately live in metropolitan areas, we analyzed the association between travel time and initial LDCT completion within an integrated, urban safety-net health care system.
Using Esri's StreetMap Premium, OpenStreetMap, and the r5r package in R, we determined projected private vehicle and public transportation travel times between patient residence and the screening facility for LDCT ordered in March 2017 through December 2022 at Parkland Memorial Hospital in Dallas, Texas. We characterized associations between travel time and LDCT completion in univariable and multivariable analyses. We tested these associations in a simulation of 10,000 permutations of private vehicle and public transportation distribution.
A total of 2,287 patients were included in the analysis, of whom 1,553 (68%) completed the initial ordered LDCT. Mean age was 63 years, and 73% were underrepresented minorities. Median travel time from patient residence to the LDCT screening facility was 17 minutes by private vehicle and 67 minutes by public transportation. There was a small difference in travel time to the LDCT screening facility by public transportation for patients who completed LDCT versus those who did not (67 vs 66 min, respectively; P=.04) but no difference in travel time by private vehicle for these patients (17 min for both; P=.67). In multivariable analysis, LDCT completion was not associated with projected travel time to the LDCT facility by private vehicle (odds ratio, 1.01; 95% CI, 0.82-1.25) or public transportation (odds ratio, 1.14; 95% CI, 0.89-1.44). Similar results were noted across travel-type permutations. Black individuals were 29% less likely to complete LDCT screening compared with White individuals.
In an urban population comprising predominantly underrepresented minorities, projected travel time is not associated with initial LDCT completion in an integrated health care system. Other reasons for differences in LDCT completion warrant investigation.
低剂量 CT（LDCT）肺癌筛查指南的最近修订增加了合格人群的数量，尤其是在少数族裔和族裔群体中。由于这些人群不成比例地居住在大都市区，因此我们分析了在一个综合的城市医疗保健网络中，旅行时间与初始 LDCT 完成之间的关系。
使用 Esri 的 StreetMap Premium、OpenStreetMap 和 R 中的 r5r 包，我们确定了 2017 年 3 月至 2022 年 12 月期间在德克萨斯州达拉斯市的 Parkland Memorial 医院下达的 LDCT 与患者居住地和筛查设施之间的私人车辆和公共交通预计旅行时间。我们在单变量和多变量分析中描述了旅行时间与 LDCT 完成之间的关联。我们在对私人车辆和公共交通分布的 10000 次随机排列的模拟中测试了这些关联。
共有 2287 名患者纳入分析，其中 1553 名（68%）完成了初始预定的 LDCT。平均年龄为 63 岁，73%是代表性不足的少数族裔。从患者居住地到 LDCT 筛查设施的私人车辆平均旅行时间为 17 分钟，公共交通为 67 分钟。完成 LDCT 的患者与未完成 LDCT 的患者前往 LDCT 筛查设施的公共交通旅行时间差异较小（分别为 67 分钟和 66 分钟；P=.04），但私人车辆旅行时间无差异（均为 17 分钟；P=.67）。多变量分析显示，LDCT 完成与私人车辆前往 LDCT 设施的预计旅行时间无关（优势比，1.01；95%CI，0.82-1.25）或公共交通（优势比，1.14；95%CI，0.89-1.44）。在旅行类型的随机排列中也观察到类似的结果。与白人相比，黑人完成 LDCT 筛查的可能性低 29%。
在一个以代表性不足的少数族裔为主的城市人群中，在一个综合的医疗保健系统中，预计旅行时间与初始 LDCT 完成无关。LDCT 完成差异的其他原因需要进一步调查。
