Disparities in lung cancer screening among patients in socioeconomically distressed communities

Lung cancer screening reduces mortality, but the role of socioeconomic factors in screening rates is unclear. We used the Distressed Communities Index to evaluate how socioeconomic distress impacts lung cancer screening.

We retrospectively reviewed patients screened for lung cancer at a single institution from July 25, 2016, to January 18, 2024. Distressed Communities Index scores ranged from 0 (no distress) to 100 (severe distress) and were grouped into quintiles. County-level US Census data were used for comparison.

Of 864 patients who underwent screening, 39%, 18%, 16%, 11%, and 16% were in the first, second, third, fourth, and fifth quintiles, respectively. Patients in distressed quintiles had increased rates of active cigarette use (P = .016), minority race (P = .002), and Medicaid health insurance (P < .001). Patients from the highest distress communities were overrepresented in screenings (screened: 16.2% vs county: 10.0%, P < .001), whereas those in mid-tier (screened: 16.4% vs county: 19.7%, P = .015) and at-risk (screened: 11.1% vs county: 13.7%, P = .026) communities were marginally underrepresented. The screened population was predominantly of non-Hispanic White race (screened: 85.0% vs county: 53.3%, P < .001). Hispanic (screened: 5.9% vs county: 30.6%, P < .001) and Asian (screened: 1.6% vs county: 4.5%, P < .001) populations, but not Black populations (screened: 5.3% vs county: 5.5%, P = .882), were underrepresented. Time to biopsy and malignancy rates were similar across Distressed Communities Index quintiles and racial groups.

Minorities face disparities in lung cancer screening access, but when screened, they have outcomes similar to those of nonminorities. The Distressed Communities Index effectively identified communities that could benefit from targeted interventions to improve screening access.