Thoracic Surgery and Interventional Pulmonology Clinic, Swedish Medical Center and Cancer Institute, Seattle, WA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA.
Thoracic Surgery and Interventional Pulmonology Clinic, Swedish Medical Center and Cancer Institute, Seattle, WA.
Chest. 2024 Sep;166(3):622-631. doi: 10.1016/j.chest.2024.04.021. Epub 2024 May 28.
Early detection of lung cancer reduces cancer mortality; yet uptake for lung cancer screening (LCS) has been limited in Washington State. Geographic disparities contribute to low uptake, but do not wholly explain gaps in access for underserved populations. Other factors, such as an adequate workforce to meet population demand and the capacity of accredited screening facility sites, must also be considered.
What proportion of the eligible population for LCS has access to LCS facilities in Washington State?
We used the enhanced two-step floating catchment area (E2SFCA) model to evaluate how geographic accessibility in addition to availability of LCS imaging centers contribute to disparities. We used available data on radiologic technologist volume at each American College of Radiology (ACR)-accredited screening facility site to estimate the capacity of each site to meet potential population demand. Spearman rank correlation coefficients of the spatial access ratios were compared with the 2010 Rural-Urban Commuting Area codes and area deprivation index quintiles to identify characteristics of populations at risk for lung cancer with greater and lesser levels of access.
A total of 549 radiologic technologists were identified across the 95 ACR-accredited screening facilities. We observed that 95% of the eligible population had proximate geographic access to any ACR facility. However, when we incorporated the E2SFCA method, we found significant variation of access for eligible populations. The inclusion of the availability measure attenuated access for most of the eligible population. Furthermore, we observed that rural areas were substantially correlated, and areas with greater socioeconomic disadvantage were modestly correlated, with lower access.
Rural and socioeconomically disadvantaged areas face significant disparities. The E2SFCA models demonstrated that capacity is an important component and how geographic access and availability jointly contribute to disparities in access to LCS.
早期发现肺癌可降低癌症死亡率；然而，华盛顿州的肺癌筛查（LCS）参与率有限。地理差异导致参与率低，但并不能完全解释服务不足人群获得机会的差距。其他因素，如满足人口需求的足够劳动力以及认证筛查机构地点的能力，也必须考虑在内。
有多少符合 LCS 条件的人口可以获得华盛顿州的 LCS 设施？
我们使用增强型两步浮动集水区（E2SFCA）模型来评估地理可达性以及 LCS 成像中心的可用性如何促成差异。我们利用每个美国放射学院 (ACR) 认证筛查机构地点的放射技师数量的可用数据来估计每个地点满足潜在人口需求的能力。空间可达性比率的斯皮尔曼等级相关系数与 2010 年农村-城市通勤区代码和区域贫困指数五分位数进行比较，以确定具有更高和更低肺癌风险的人群的特征。
在 95 个 ACR 认证的筛查机构中，共确定了 549 名放射技师。我们观察到，95%的合格人口都可以接近任何 ACR 设施进行地理访问。然而，当我们纳入 E2SFCA 方法时，我们发现合格人群的访问情况存在显著差异。可用性措施的纳入降低了大多数合格人群的访问量。此外，我们观察到农村地区的相关性较大，而社会经济劣势较大的地区的相关性适度，访问量较低。
农村和社会经济劣势地区面临着显著的差异。E2SFCA 模型表明，能力是一个重要组成部分，以及地理可达性和可用性如何共同促成 LCS 获得机会的差异。
