Patients with high distressed communities index score are at risk for "no-show" to lung cancer screening appointments

Randomized data support the mortality benefit of lung cancer screening (LCS); however, completion rates among those meeting eligibility criteria remain concerningly low. The Distressed Communities Index (DCI) is a composite socioeconomic metric assessed by ZIP code. We sought to investigate the association between DCI and completion of scheduled LCS appointments.

A retrospective study was conducted in patients scheduled for LCS with low-dose computed tomography at a high-volume center in 2021. Patients were marked as a "no-show" when they missed or canceled their scheduled screening appointment. The association between DCI and screening no-show rates was modeled using a stepwise approach.

A total of 1114 patients were scheduled for LCS, of whom 83.5% (n = 928) resided in ZIP codes considered "at-risk" or "distressed" in terms of socioeconomic distress based on their DCI score. In the entire cohort, 18.4% of patients (n = 205) did not attend any screening appointments scheduled within the year. Patients in the "at-risk" and "distressed" categories were more likely to have a no-show (19.5% vs 12%; P = .015). A higher DCI score was associated with increased probability of screening noncompletion on univariable analysis (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.01-1.03; P = .002). On multivariable analysis, additional factors associated with higher likelihood of a no-show included current smoking status (adjusted OR [aOR], 2.59; 95% CI, 1.70-3.96) and initial screening (aOR, 2.07; 95% CI, 1.43-3.00).

Higher DCI scores are associated with increased no-show rates for LCS appointments. This tool can be used to target populations at risk of underscreening and associated lung cancer mortality with navigational support or novel interventions to increase screening.