Mortality in a Diverse, Real-World Lung Cancer Screening Cohort

Lung cancer screening (LCS) is indicated exclusively for older individuals with substantial tobacco use, a risk factor not only for lung cancer but also for other malignancies, cardiovascular disease, and chronic obstructive pulmonary disease. Because LCS trial populations are commonly regarded as healthier than the broader LCS-eligible population, the real-world mortality rate among individuals undergoing LCS represents a key consideration in LCS implementation.

We performed a retrospective, observational cohort study of individuals for whom LCS was ordered between March 2017 and December 2022 in an integrated safety-net healthcare system. Demographic characteristics and Charlson comorbidity index were obtained from the medical record. Dates and causes of death were captured from the medical record and National Death Index. We compared mortality according to patient characteristics using Cox proportional hazard ratios.

A total of 1598 patients (mean age 62 years, 43% female, 45% Black, 18% Hispanic) were included in the analysis, of whom 60% had moderate and 20% severe comorbidity; 91% of patients were current smokers. With a median follow-up of 31.3 months, 93 patients (6%) had died. For patients without a date of death, 55% had an encounter in the healthcare system within 3 months of data collection. Mortality was significantly associated with age (HR 1.06; 95% CI, 1.02-1.11; P = .01), but not with patient sex, race, comorbidity, smoking status, or LCS completion.

Despite substantial comorbidity burden, short-term mortality is low in a diverse, real-world LCS population, suggesting potential for benefit from screening and early detection of lung cancer.