ASPO Abstracts
Disparities in Lung Cancer Screening Accessibility and Utilization in South Carolina
Category: Cancer Health Disparities
Conference Year: 2022
Abstract Body:
Purpose: 1) To investigate the differences in lung cancer screening (LCS) accessibility by county level rurality and other socioeconomic status (SES) factors in South Carolina (SC); 2) To examine the individual and county level predictors of LCS utilization.Methods: A list of LCS sites were identified from the American College of Radiology. We defined access to LCS as <30 minutes driving time from the centroid of the census block group to the nearest LCS site. At a county level, the access of each block group was weighted by the proportion of population aged 55-80 years in the county. County level rurality was determined by Rural-Urban Continuum Codes, with 1-3 for urban counties and 4-9 for rural counties. County level income, education, and the prevalence of minority population were obtained from Census 2010. Data from 2017 SC Adult Tobacco Survey (ATS) was used to examine the individual level (age, sex, race, education, marital status, insurance, income, smoking status, chronic obstructive pulmonary disease (COPD)) and county level predictors (rurality, LCS accessibility) of LCS utilization. Chi-square test, Students' t-test, Pearson correlation, and multilevel logistic regression were used in the analyses.Results: SC has 46 (26 urban and 20 rural) counties. As of August 2021, 72 population-based LCS sites have been established, including 63 sites located in 18 urban counties and 9 sites in 9 rural counties. The driving time to the nearest LCS site ranged from <5 to 60 minutes, with an average of 13.7 minutes. Overall, 74.9% of the residents aged 55-80 had access to LCS. About 85.4% of urban residents vs. 61.3% of rural residents had access to LCS (P=0.004). Counties with worse SES had significantly lower access to LCS (P<0.05). A total of 1,441 current or former smokers aged 55-80 were identified from ATS data, of whom 19.8% used LCS. Being female, black, and having COPD were significantly associated with increased LCS utilization. County level rurality and LCS accessibility were not significant predictors.Conclusions: In SC, residents in the rural counties and counties with lower SES had less access to LCS. After adjusting for individual level covariates, county level covariates were not significant in predicting LCS utilization.
Keywords: lung cancer screening, accessibility, utilization, disparity, South Carolina