ASPO Abstracts
Disparities in Radon Testing among Vulnerable Populations in North Carolina
Category: Cancer Health Disparities
Conference Year: 2023
Abstract Body:
Purpose of the study: Radon exposure is the leading cause of lung cancer among non-smokers and contributes to 21,000 lung cancer deaths annually in the U.S. Home radon testing and mitigation can decrease radon levels by 50-90% and effectively reduce the risk of lung cancer. However, awareness of radon is lower among vulnerable populations defined by social determinants of health (SDOH), including race/ethnicity and education, which may contribute to disparities in radon testing. Using statewide data, we characterized the likelihood of radon testing among vulnerable populations in North Carolina (NC). Methods: We conducted a novel data linkage between the largest radon testing company in NC (~60% of all radon tests in the state) and the National Neighborhood Data Archive to obtain SDOH characteristics for 26,020 unique NC homes that tested for radon between 2010-2022. We analyzed the proportion of radon tests conducted by zip code-level quartiles of proportion Black, proportion with less than a high school education, and proportion with socioeconomic (SES) disadvantage (defined by four SES indicators) among all NC counties (n=100) and among NC counties in the highest quartile of lung cancer incidence rates. Results: A lower proportion of radon testing occurred in areas with a higher proportion of residents who were Black (highest quartile Black: 14% of all radon tests vs. lowest quartile Black: 26%); <high school education (highest quartile low education: 9% vs. lowest quartile low education: 38%); and SES disadvantage (highest quartile disadvantage: 14% vs. lowest quartile disadvantage: 32%). When analysis was limited to counties with the highest lung cancer rates, no clear trends were observed by education or SES disadvantage. However, the testing disparity by Black race persisted (highest quartile Black: 15% of all radon tests vs. lowest quartile Black: 31%). Conclusions: The EPA recommends universal home radon testing, regardless of geographic region, because of the influence of housing characteristics on individual-level radon exposure. These data reveal striking disparities by SDOH in the likelihood of radon testing in NC and highlight the need to promote more widespread radon awareness and testing, particularly among vulnerable populations.
Keywords: Health Disparities; Radon; Lung Cancer