Individual- and Group-Level Disparities Between Racial and Ethnic Groups in Lung Cancer Screening Eligibility...

Area of Science:

• Public Health
• Health Services Research
• Health Equity

Background:

• Current lung cancer screening guidelines lead to disparities in eligibility and benefit across racial and ethnic groups.
• Existing criteria may not equitably serve all individuals who could benefit from lung cancer screening.

Purpose of the Study:

• To evaluate how enforcing equal lung cancer screening eligibility and program sensitivity across racial and ethnic subgroups impacts screening outcomes.
• To inform lung cancer screening policy development for improved equity.

Main Methods:

• Cross-sectional comparative effectiveness study using data from the 2015 National Health Interview Survey (NHIS).
• Included 6915 US adults aged 50-80 years who ever smoked.
• Analyzed lung cancer screening eligibility using the Life-Years Gained from Screening-Computed Tomography (LYFS-CT) model.

Main Results:

• Enforcing equal screening eligibility across races/ethnicities requires different benefit thresholds, leading to unequal eligibility for individuals with the same predicted benefit.
• A fixed eligibility threshold results in significant disparities, with 7% of Hispanic Americans and 27% of African Americans eligible.
• Equalizing program sensitivity across groups also reveals disparities, with Hispanic Americans potentially facing a worse benefit-harm balance.

Conclusions:

• Lung cancer screening eligibility criteria cannot simultaneously ensure equal eligibility for individuals with equal benefit and equal program sensitivity across racial and ethnic groups.
• Race- and ethnicity-specific thresholds aiming for equal group-level sensitivity on one metric do not achieve equal sensitivity on others.
• Policy decisions must prioritize which metric (eligibility or sensitivity) to equalize, requiring a value judgment.