Lung cancer screening uptake in patients with rheumatoid arthritis in community settings

Individuals with rheumatoid arthritis (RA), particularly those with a history of smoking, are at increased risk for lung cancer. However, real-world data on the use of low dose computed tomography (LDCT) screening for lung cancer in this population are lacking. Therefore, we assessed the rates, trends, and predictors of LDCT screening among patients with a smoking history and RA. A retrospective cohort study using the IQVIA PharMetrics® Plus for Academics Closed Health Plan claims database was conducted. Patients with RA diagnosed in 2014-2023, aged 50-77 years, and with a history of smoking and no prior cancer or advanced respiratory illness were identified. LDCT screening was identified using Healthcare Common Procedure Coding System codes. Among 15,341 eligible patients, 997 (6.5%) received LDCT screening; median time from RA diagnosis to first LDCT claim was 452 days. In a sensitivity analysis of 12,301 patients with continuous insurance coverage during the 12 months after RA diagnosis, only 367 (3%) underwent LDCT within the first year after RA diagnosis. Demographic factors such as male sex (aOR=1.24; p=0.003), age 55-69 (aOR=~1.90; p<0.0001), and residence outside the West region (p<0.0001) increased uptake. Clinical characteristics and healthcare utilization such as COPD (aOR=2.85; p<0.0001), more outpatient visits (aOR=2.15-2.41; p< 0.001) and DMARD use (aOR=1.27-1.52; p≤ 0.001) also increased odds, whereas greater comorbidity burden reduced screening (aOR=0.79-0.39; p≤0.006). In conclusion, LDCT rates in patients with RA remained low overall and varied according to demographic and clinical factors. Targeted efforts may be needed to improve screening uptake in this high-risk population.