Lung Cancer Screening among Adults Older than Medicare's Upper Age Eligibility Criteria

Implications on the loss of lung cancer screening (LCS) coverage among Medicare recipients aged 77+ years have not been explored. We use a 2022 Behavioral Risk Factor Surveillance System dataset to examine LCS patterns of screen-eligible adults across three age groups: 65 to 70, 71 to 77, and 78 to 79 years. In descriptive analyses, LCS-eligible respondents are compared by screening status across each age category. In regression analyses, we explore various sociodemographic and health-related factors that may help explain age-related differences between these groups. Less than a third of our sample reported LCS in the last year (26.3%). Among eligible respondents, adults aged 78 to 79 years reported the highest LCS rates (32.0%), followed by adults aged 71 to 77 years (28.3%) and 65 to 70 years (24.2%). Respondents aged 78 to 79 years and 65 to 70 years with chronic obstructive pulmonary disease indicated significantly increased LCS odds [OR, 3.37; 95% confidence interval (CI), 1.12-10.11 and OR, 2.91; 95% CI, 1.98-4.27, respectively]. Respondents aged 78 to 79 years with history of a heart attack or kidney disease indicated significantly decreased LCS odds (OR, 0.08; 95% CI, 0.01-0.62 and OR, 0.06; 95% CI, 0.01-0.56, respectively). Respondents aged 71 to 77 years with coronary heart disease indicated a significantly decreased LCS odds (OR, 0.54; 95% CI, 0.30-0.96). Although loss of Centers for Medicare & Medicaid Services coverage for LCS is not associated with lower screening among Behavioral Risk Factor Surveillance System adults aged 78 to 79 years, clinicians should continue to consider the appropriateness of treatment for older LCS-eligible adults with chronic health conditions.

Persons who reach the age of 78 years are no longer eligible for LCS coverage from Medicare. This study fills an important knowledge gap by comparing LCS patterns among a nationally representative sample of Medicare-eligible adults aged 78 to 79 years with their younger counterparts aged 65 to 77 years, for whom Centers for Medicare & Medicaid Services covers LCS. See related Spotlight, p. 655.