Lung Cancer Screening Disparities in Asian American Subgroups in a Large Integrated Health System

Area of Science:

• Oncology
• Public Health
• Health Disparities

Background:

• Lung cancer is the leading cause of cancer-related deaths among Asian Americans (AsA).
• Lung cancer screening (LCS) rates within the AsA population remain largely unknown.
• Kaiser Permanente Northern California (KPNC) offers LCS as a member benefit, with a California state LCS rate of 0.7%.

Purpose of the Study:

• To examine and compare lung cancer screening rates among various Asian American subgroups within KPNC.
• To analyze LCS rates using both the 2013 and 2021 United States Preventive Services Task Force (USPSTF) guidelines.

Main Methods:

• A cohort study analyzing electronic health records from KPNC between 2015 and 2022.
• Comparison of LCS rates across disaggregated AsA subgroups, controlling for sociodemographics.
• Application of both the more restrictive 2013 and more inclusive 2021 USPSTF LCS guidelines.

Main Results:

• Overall KPNC LCS rates for eligible AsA patients were 4.3% (2013 guidelines) and 2.7% (2021 guidelines), significantly exceeding the California rate.
• LCS rates demonstrated significant heterogeneity among AsA subgroups under both guideline sets.
• Under 2021 guidelines, Chinese (4.0%) and Korean (3.57%) subgroups had higher screening rates compared to Filipino (1.55%) and Pacific Islander (1.91%) subgroups.

Conclusions:

• This study is the first to reveal substantial variation in LCS rates among disaggregated AsA subgroups.
• KPNC LCS rates were approximately four times higher than California rates, suggesting potential for improved screening when financial barriers are removed.
• Systemic and culturally sensitive interventions are crucial to enhance overall LCS rates and address disparities within specific AsA populations.