Lewis Jennifer A, Stranick Allison, Pennings Jacquelyn, Samuels Lauren R, Byerly Susan, Helton John, Park Daniel, Winter Robert, Matheny Michael E, Henschke Claudia I, Yankelevitz David F, Hendler Fred, York Sally J, Callaway-Lane Carol, Tindle Hilary A, Dittus Robert S, Moghanaki Drew, Spalluto Lucy B, Roumie Christianne L
Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC) and the VETWISE-LHS Center of Innovation, Nashville, Tennessee; Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Nashville, Tennessee; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee.
Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC) and the VETWISE-LHS Center of Innovation, Nashville, Tennessee; Vanderbilt University, Nashville, Tennessee.
Am J Prev Med. 2025 May;68(5):886-895. doi: 10.1016/j.amepre.2025.01.015. Epub 2025 Jan 27.
Lung cancer screening is underutilized, especially in rural areas where lung cancer mortality is high. Approximately 11.2% of the U.S. population over age 50 years meet the U.S. Preventive Services Task Force (USPSTF) 2021 lung cancer screening eligibility criteria; the proportion of eligible Veterans is unknown. This study evaluated the proportion of Veterans who are USPSTF-eligible and tested the hypothesis that more USPSTF 2021-eligible Veterans reside in rural versus nonrural areas.
Investigators cross-sectionally surveyed a national sample of Veterans aged 50 years and older January-November 2022. Oversampling ensured inclusion of minority groups and accounted for geographic variation in tobacco use. Analyses in 2023-2024 evaluated the proportion of USPSTF-eligible Veterans by year (2013 and 2021) and tested USPSTF-2021 eligibility by rural status (rural versus nonrural) using chi square tests. Weighting accounted for survey nonresponse and applied results to the whole Veteran population in a sensitivity analysis.
Of 2,000 surveyed, 754 responded (37.7% response rate); most respondents were White (74.4%), male (92.6%), and resided in nonrural areas (66.0%). Proportions meeting USPSTF criteria were 35.5% (95% CI=31.6%, 39.6%) in 2021 and 27.8% (95% CI=24.3%, 31.7%) in 2013. The proportion of USPSTF 2021-eligible rural Veterans (41.2%; 95% CI=34.8%, 48.0%) was higher compared with nonrural (32.5%; 95% CI=27.7%, 37.7%), p=0.037. A sensitivity analysis found the proportion of Veterans USPSTF 2021 eligible in the whole population was 33.0%.
The proportion of Veterans USPSTF2021 eligible was nearly 3 times higher than the general U.S. population (11.2%), and a greater proportion of eligible Veterans resided in rural compared with nonrural areas. These findings are critical for policies aimed at fully implementing lung cancer screening at scale.
肺癌筛查的利用率较低，尤其是在肺癌死亡率较高的农村地区。在美国，年龄超过50岁的人群中，约11.2%符合美国预防服务工作组（USPSTF）2021年肺癌筛查资格标准；符合条件的退伍军人比例尚不清楚。本研究评估了符合USPSTF标准的退伍军人比例，并检验了一个假设，即与非农村地区相比，居住在农村地区且符合USPSTF 2021标准的退伍军人更多。
研究人员于2022年1月至11月对全国50岁及以上退伍军人样本进行了横断面调查。过度抽样确保纳入了少数群体，并考虑了烟草使用的地理差异。2023年至2024年的分析按年份（2013年和2021年）评估了符合USPSTF标准的退伍军人比例，并使用卡方检验按农村状况（农村与非农村）检验了USPSTF-2021资格。加权考虑了调查无应答情况，并在敏感性分析中将结果应用于整个退伍军人总体。
在2000名接受调查的人中，754人作出了回应（回应率为37.7%）；大多数受访者为白人（74.4%）、男性（92.6%），居住在非农村地区（66.0%）。2021年符合USPSTF标准的比例为35.5%（95%CI=31.6%，39.6%），2013年为27.8%（95%CI=24.3%，31.7%）。符合USPSTF 2021标准的农村退伍军人比例（41.2%；95%CI=34.8%，48.0%）高于非农村地区（32.5%；95%CI=27.7%，37.7%），p=0.037。敏感性分析发现，在整个人口中符合USPSTF 2021标准的退伍军人比例为33.0%。
符合USPSTF2021标准的退伍军人比例几乎是美国普通人群（11.2%）的3倍，与非农村地区相比，居住在农村地区且符合条件的退伍军人比例更高。这些发现对于旨在全面实施大规模肺癌筛查的政策至关重要。
