Geographic access to lung cancer screening among eligible adults living in rural and urban environments in the United States

Abstract

BACKGROUND:Although recommended lung cancer screening with low-dose computed tomography scanning (LDCT) reduces mortality among high-risk adults, annual screening rates remain low. This study complements a previous nationwide assessment of access to lung cancer screening within 40 miles by evaluating differences in accessibility across rural and urban settings for the population aged 50 to 80 years and a subset eligible population based on the 2021 US Preventive Services Task Force LDCT lung screening recommendations. METHODS: Distances from population centers to screening facilities (American College of Radiology Lung Cancer Screening Registry) were calculated, and the number of individuals who had access within graduating distances, including 10, 20, 40, 50, and 100 miles, were estimated. Census tract results were aggregated to counties, and both geographies were classified with rural-urban schemas. RESULTS: Approximately 5% of the eligible population did not have access to lung cancer screening facilities within 40 miles; however, different patterns of accessibility were observed at different distances, between regions, and across rural-urban environments. Across all distances and geographies, there was a larger percentage of the population in rural geographies with no access. Although the rural population represented approximately 8% of the eligible population, the larger percentage of the rural population with no access was noteworthy and translated into a larger number of individuals with no access at longer distance thresholds (≥40 miles). CONCLUSIONS: Disparities in access should be examined as both percentages of the population and numbers of individuals with no access in order to tailor interventions to communities and increase access. Geospatial analysis at the census tract level is recommended to help to identify optimal focus areas and reach the most people.

Impact of U.S. Preventive Services Task Force lung cancer screening update on drivers of disparities in screening eligibility

“…Similar work has suggested that approximately 5% of the screening eligible population is located more than 40 miles from a screening facility 29 and accessibility to screening locations is associated with population density 30 . Moreover, an analysis of census tract‐level socioeconomic characteristics and distance to ACR‐accredited computed tomography (CT) facilities showed increased driving distances to CT facilities for census tracts with higher proportions of individuals who are uninsured, have Medicaid, and have less than a high school degree 31 .…”

“…Within this analysis, geographic proximity was operationalized as a 60-minute drive; the results showed a cluster of SCOEs in the Northeastern and Midwestern regions, with a broad band of high-mortality counties spread throughout the Appalachian and Southeastern US with limited access to SCOEs. 28 Similar work has suggested that approximately 5% of the screening eligible population is located more than 40 miles from a screening facility 29 and accessibility to screening locations is associated with population density. 30 Moreover, an analysis of census tract-level socioeconomic T A B L E 1 (Continued) characteristics and distance to ACR-accredited computed tomography (CT) facilities showed increased driving distances to CT facilities for census tracts with higher proportions of individuals who are uninsured, have Medicaid, and have less than a high school degree.…”

Are Wellness Visits a Possible and Effective Cure for the Increasing Cancer Burden in Poland? Example of Women’s Preventive Services in the U.S.

“…2 for lung cancer screening. For the latter, because approved lung cancer screening programs for patients with eligible smoking histories had just begun to be implemented in our study region within the timeframe of our study and were not offered in many county locations [ 19 ], the outcomes for use of lung cancer screening were calculated for all eligible beneficiaries located in a sample of 20 counties selected as having the most lung cancer screening claims ( Figure 2 and Table 1 ). Moreover, because we lacked data on smoking status, the effects of wellness visits was estimated at the Medicare insured population level among all female beneficiaries; thus, we could not estimate effects specifically for smokers.…”

Lung Cancer Screening

“…For example, compared with the general population, the individuals eligible for screening are more likely to be poor, uninsured, or enrolled in Medicaid and are twice as likely to report their health status as poor, 35 and individuals who live in more rural states live at a substantially further distance to a screening CT facility than individuals in urban and suburban populations. 36 Intentional community outreach programs with or alongside members of the community to address these health care disparities provide an opportunity to reach individuals at risk who may face obstacles to screening. Depending on one's practice scope and reach, telehealth may play a role in shared decision-making visits and tobacco consultation services, and mobile CT platforms may extend the reach of programs into populations from the inner city to rural areas.…”