ASPO Abstracts
Screening for Lung Cancer: Using Data to Set County-Level Prevention Priorities
Category: Cancer Health Disparities
Conference Year: 2019
Abstract Body:
Purpose: Although many factors contribute to lung cancer disparities in the United States,the number one modifiable risk factor is tobacco use. Rates of smoking are known to differ by state, butless information is available regarding within-state variability. We assessed county-level tobacco use withthe goal of better targeting public heath efforts within the catchment area of a multi-institution collaborativespanning Iowa, Arkansas, Illinois, Kansas, and Missouri. Methods: Using individual-level self-reported smoking data from the2011-2012 Behavioral Risk Factor Surveillance System (BRFSS) and population estimates from the 2010 U.S.Census, we created a multilevel reweighted regression model to estimate the predominance of tobacco use amongthose between the ages of 55 and 77, and eligible for lung cancer screening. For counties with less than 50eligible respondents, we used synthetic estimation, which calculated prevalence by multiplying statewide BRFSSfigures by the population within a country and aggregating over the subgroups to obtain county-specificrates.Results: The overall estimated rate of smoking in the catchment area was 19.2%, significantly higher than the nationwideaverage of 15.5%. Across counties, the prevalence of tobacco use ranged from 3.4% to 25.2%. In Missouri(n=91 counties), the average county-level incidence was 20.7%, with variability ranging from 7.21% to 23.9%. InIllinois (n=50), the mean was 18.9% with a range of 12.6% to 25.2%. In Kansas (n=32), the average was 15.5%,but counties fluctuated between 3.4% to 20.1%. In Iowa (n=5), prevalence ranged from 18.7% to 20%, andin Arkansas (n=3), prevalence ranged from 9.45% to 20.6%. Conclusion: There is significant within-stateheterogeneity in the county-level prevalence of tobacco use. Since state-level information masks the variability thatexists, assessing and monitoring county-level disparities in tobacco use and those eligible for lung cancerscreening should guide public health efforts to increase screening and, therefore, reduce lung cancer mortality. Futurestudies should focus on developing effective multilevel strategies for tobacco control interventions tosubstantially decrease the prevalence and eliminate geographic disparity of use.
Keywords: lung cancer, tobaccouse, disparity