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Showing content from https://pubmed.ncbi.nlm.nih.gov/33155970/ below:

Urban-Rural Disparities in Access to Low-Dose Computed Tomography Lung Cancer Screening in Missouri and Illinois

doi: 10.5888/pcd17.200202. Urban-Rural Disparities in Access to Low-Dose Computed Tomography Lung Cancer Screening in Missouri and Illinois

Affiliations

¹ Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
² Division of Public Health Sciences, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8100, St Louis, MO 63110. Email: karthik.rohatgi@wustl.edu.
³ Department of Medical Social Sciences, Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

PMID: 33155970
PMCID: PMC7665516
DOI: 10.5888/pcd17.200202

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Urban-Rural Disparities in Access to Low-Dose Computed Tomography Lung Cancer Screening in Missouri and Illinois

Karthik W Rohatgi et al. Prev Chronic Dis. 2020.

doi: 10.5888/pcd17.200202. Affiliations

¹ Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
² Division of Public Health Sciences, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8100, St Louis, MO 63110. Email: karthik.rohatgi@wustl.edu.
³ Department of Medical Social Sciences, Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

PMID: 33155970
PMCID: PMC7665516
DOI: 10.5888/pcd17.200202

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Erratum in

Erratum, Vol. 17, November 5 Release.
[No authors listed] [No authors listed] Prev Chronic Dis. 2022 Apr 7;19:E17. doi: 10.5888/pcd19.200202e. Prev Chronic Dis. 2022. PMID: 35389832 Free PMC article.

Abstract

Introduction: Low-dose computed tomography (LDCT) lung cancer screening is recommended for current and former smokers who meet eligibility criteria. Few studies have quantitatively examined disparities in access to LDCT screening. The objective of this study was to examine relationships between 1) rurality, sociodemographic characteristics, and access to LDCT lung cancer screening and 2) screening access and lung cancer mortality.

Methods: We used census block group and county-level data from Missouri and Illinois. We defined access to screening as presence of an accredited screening center within 30 miles of residence as of May 2019. We used mixed-effects logistic models for screening access and county-level multiple linear regression models for lung cancer mortality.

Results: Approximately 97.6% of metropolitan residents had access to screening, compared with 41.0% of nonmetropolitan residents. After controlling for sociodemographic characteristics, the odds of having access to screening in rural areas were 17% of the odds in metropolitan areas (95% CI, 12%-26%). We observed no association between screening access and lung cancer mortality. Southeastern Missouri, a rural and impoverished area, had low levels of screening access, high smoking prevalence, and high lung cancer mortality.

Conclusion: Although access to LDCT is lower in rural areas than in urban areas, lung cancer mortality in rural residents is multifactorial and cannot be explained by access alone. Targeted efforts to implement rural LDCT screening could reduce geographic disparities in access, although further research is needed to understand how increased access to screening could affect uptake and rural disparities in lung cancer mortality.

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Figures
Figure 1

Measures of rurality in Missouri…

Figure 1

Measures of rurality in Missouri and Illinois and location of low-dose computed tomography…

Figure 1

Measures of rurality in Missouri and Illinois and location of low-dose computed tomography screening centers. A, Rural–urban commuting area (RUCA) categories at the census tract level, determined by US Department of Agriculture Economic Research Service (16). B, National Center for Health Statistics (NCHS) rural–urban classification codes at the county level (17). Data on screening centers obtained from American College of Radiology (11) and GO₂ Foundation for Lung Cancer (12). Shapefiles obtained from ESRI (20).

Figure 2

Access to LDCT lung cancer…

Figure 2

Access to LDCT lung cancer screening, lung cancer mortality, and smoking prevalence in…

Figure 2

Access to LDCT lung cancer screening, lung cancer mortality, and smoking prevalence in Missouri and Illinois. A, Percentage of residents aged 55–79 with access to an LDCT lung cancer screening center within 30 miles. B, Lung cancer mortality (deaths per 100,000) among adults aged ≥60. C, Adult smoking prevalence. All maps are at the county level, and categories are based on rounded quintiles. Data obtained from American College of Radiology (11), GO₂ Foundation for Lung Cancer (12), Surveillance, Epidemiology, and End Results program (18), and County Health Rankings (19). Shapefiles from ESRI (20). Abbreviation: LDCT, low-dose computed tomography.