Racial disparities may exist in access to lung cancer screening facilities

1. In this cross-sectional study, distance to the nearest lung cancer screening facility was greater in American Indian/Alaska Native-majority census tracts compared to non-Hispanic White-majority census tracts, even after adjustment for rurality.

2. Asian-, Black-, and Hispanic-majority census tracts exhibited shorter distances to lung cancer screening facilities than non-Hispanic White-majority census tracts.

Evidence Rating Level: 2 (Good)

Study Rundown: Despite advancements in immunotherapy and targeted therapy, lung cancer remains the third most common cancer and the leading cause of cancer-related mortality in the United States. Early-stage diagnosis has been shown to significantly improve prognosis, highlighting the importance of appropriate screening. As part of its most recent guidelines released in 2021, the United States Preventive Services Task Force (USPSTF) recommended annual lung cancer screening for individuals aged 50 to 80 years with at least a 20-pack year smoking history who currently smoke or have quit within the past 15 years. Previous studies have shown greater lung cancer mortality among non-Hispanic White, non-Hispanic Black, and non-Hispanic American Indian/Alaska Native (AI/AN) people, and that the national trend of decreasing lung cancer mortality was less prominent among people living in rural areas. Given that AI/AN people are the most rural population and have the highest prevalence of smoking in the United States, this cross-sectional ecological study investigated differences in access to lung cancer screening facilities by race, ethnicity, and rurality, with a specific focus on comparing AI/AN people with the non-Hispanic White population. Overall, distance to the nearest lung cancer screening facility was found to be longer in American Indian/Alaska Native-majority census tracts compared to non-Hispanic White-majority census tracts even after adjustment for rurality. On the other hand, Asian-, Black-, and Hispanic-majority census tracts exhibited shorter distances to lung cancer screening facilities than non-Hispanic White-majority census tracts. This study was limited by an inability to consider several factors including facility capacity, insurance coverage, and travel cost, which may have impacted access to lung cancer screening beyond travel distance alone.

Click to read the study in AIM

Relevant Reading: Rural-urban disparities in lung cancer-related mortality in the United States

In-Depth [cross-sectional study]: This cross-sectional study examined the differences in access to lung cancer screening facilities by race, ethnicity, and rurality with a focus on AI/AN people. The primary outcome was the road network distance in miles between a census tract (2500 to 8000 people) in the United States and the nearest lung cancer screening facility. The percentage of AI/AN, Asian, Black, non-Hispanic White, other race, and Hispanic people were calculated for each census tract and a majority tract was defined as one in which more than 50% of its residents identified with one of the racial or ethnic categories. Rurality was defined using rural-urban commuting area (RUCA) codes and tracts with no RUCA designation were excluded from analysis. The study included 71,691 of 72,757 census tracts in the United States. The overall geometric mean distance to the nearest lung cancer screening facility was 6.5 miles. AI/AN-majority tracts had the longest mean distance at 49.6 miles, whereas the distance to screening facilities for other majority tracts ranged between 4.4 to 6.9 miles. Distances to the nearest screening facility in AI/AN-majority tracts were 5.26 times (426%) farther (95% confidence interval [CI], 4.62 to 5.99) than those in non-White Hispanic-majority tracts. Distances in Asian-, Black-, and Hispanic-majority census tracts were 16% (geometric mean ratio [GMR], 0.84 [95% CI, 0.79 to 0.90]), 39% (GMR, 0.61 [95% CI, 0.59 to 0.63]), and 7% (GMR, 0.93 [95% CI, 0.90 to 0.95]) shorter, respectively, than those in non-White Hispanic-majority tracts. The mean distance in AI/AN-majority tracts was 3.16 times farther than that in non-White Hispanic-majority tracts despite adjustment for RUCA categories. In summary, this study demonstrated differences in distance to lung cancer screening facilities between races and ethnicities which are only partially attributable to rurality.

Image: PD

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