ASPO Abstracts
Factors Associated with Low-Dose CT Lung Cancer Screening Adherence in a High Burden State
Category: Early Detection & Risk Prediction
Conference Year: 2020
Abstract Body:
Background: Lung cancer is the leading cause of cancer death in the U.S. The burden of
lung cancer varies substantially by region and state, primarily due to historical differences
in the prevalence of cigarette smoking. As of 2013, the United States Preventive
Services Task Force (USPSTF) recommends lung cancer screening (LCS) with low-dose
computed tomography (LDCT) for those meeting eligibility criteria. Given the recency of
this recommendation, population-level assessments of uptake are limited and little is
known about the predictors of screening adherence. Identifying screening participation
rates and subpopulations with lower participation is an essential first step for planning
targeted interventions. Therefore, the purpose of this study was to examine LCS
eligibility, utilization, and factors associated with self-reported adherence in Oklahoma, a
state with a high smoking prevalence rate and low lung cancer survival rate.
Methods: Starting in 2017, CDC released an optional Behavioral Risk Factor Surveillance
System (BRFSS) module for LCS. Data from 596 LDCT eligible participants from the
2017 and 2018 Oklahoma BRFSS surveys were used for this study. This analysis was
restricted to data from individuals eligible for screening based on USPSTF guidelines.
Univariate analyses using Rao-Scott Chi-square tests were performed to test for
differences in the characteristics of those screened and not screened. Weighted logistic
regression models were conducted to examine the importance of independent variables
in odds of LCS services.
Results: Approximately 5.0% of Oklahomans were eligible for LCS. Only 11.31% (95%
CI: 8.02, 14.60) of eligible Oklahomans reported participating in LCS. Asthma diagnosis
(p=0.0327), chronic obstructive pulmonary disease (COPD) diagnosis (p<0.0001), and
general health status (p=0.0141) were all significantly associated with screening
participation; however, urban/rural status (p=0.091), insurance status (p=0.9272),
veteran status (p=0.2508), multiple chronic conditions (p=0.0624), and current smoking
status (p=0.5099) were not. After adjusting for age, socio-economic factors (income,
education, race), asthma status and general health status, the odds of participating in
LCS was higher (OR=2.85; 95% CI: 1.40, 5.76; p=0.0037) among
Keywords: Lung Cancer, Screening, Early detection, Eligibility