ASPO Abstracts
Racial and Insurance Type Coverage Differences in Lung Cancer Screening Utilization in a Lung Cancer Screening Program
Category: Cancer Health Disparities
Conference Year: 2022
Abstract Body:
Background: Lung cancer is the most common cause of cancer related mortality in the U.S. Early detection through Low Dose CT (LDCT) screening has been shown to curb mortality rates by as much as 20%. Despite the benefits of screening, disparities continue to exist in rates of screening and little is known regarding screening patterns in racial/ethnic, uninsured or underinsured groups. This study examined racial and insurance type coverage differences in LDCT screening utilization within an academic medical based screening program. Methods: The study used a historical cohort of N=2,324 patients who were referred and/or received a lung CT scan at our institution from January 2017 to June 2021. Data from medical records were extracted and included demographics such as race, age, gender, smoking status, and insurance type (e.g. Private, Medicare, Medicaid, Corrections, etc.). Medical records also captured whether a patient was a) referred, but didn't receive a lung CT, b) received at least one lung CT or c) received repeated lung CT scans. Number of days from order placement to lung CT receipt was also extracted. Analyses were multivariate logistic or linear regression models controlling for the above demographic variables. Results: Patients were 52.5% male; M-age= 62.7(SD = 5.9); 61.0% White and 57.6% current smokers at the time of their first CT scan. Nearly 14% (n=319) did not complete their ordered CT and 33.6% (n=780) had a repeat CT scan. Blacks compared to Whites were more likely to not receive a scan after referral (18.5% vs. 10.7%; OR = 1.77 [95%CI 1.3-2.3]; and Blacks were also less likely to have repeat scans (36.6% vs. 28.4%; OR = .746 [95%CI .613-.907]. Individuals insured through Medicaid (b=10.0 (SE = 4.54); p=.027) or Corrections' insurance (b=110.6 (SE = 34.4); p=.001) had greater days from order placement to CT scan receipt compared to other insurance types.Conclusions: Opportunity to further understand these disparities and to propose strategies to increase initial and repeat annual lung CT among Blacks and those from lower socioeconomic status is critical. Future efforts may focus on enhancing implementation strategies that include navigators and outreach staff to address patient barriers to lung cancer screening.
Keywords: lung cancer screening, racial and socioeconomic disparities, adherence to screening