Geographic access to lung cancer screening among eligible adults living in rural and urban environments in the United States

Background Although recommended lung cancer screening with low‐dose computed tomography scanning (LDCT) reduces mortality among high‐risk adults, annual screening rates remain low. This study complements a previous nationwide assessment of access to lung cancer screening within 40 miles by evaluatin...

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Bibliographic Details
Published in:Cancer 2022-04, Vol.128 (8), p.1584-1594
Main Authors: Sahar, Liora, Douangchai Wills, Vanhvilai L., Liu, Ka Kit (Antonio), Fedewa, Stacey A., Rosenthal, Lauren, Kazerooni, Ella A., Dyer, Debra S., Smith, Robert A.
Format: Article
Language:English
Subjects:
access to screening
Accessibility
Adult
Adults
Aged
Aged, 80 and over
Cancer screening
Census
Censuses
Computed tomography
Early Detection of Cancer - methods
geographic information system (GIS)
Geographic information systems
Health Services Accessibility
Humans
Lung cancer
Lung Neoplasms - diagnostic imaging
Lung Neoplasms - epidemiology
Mass Screening
Medical screening
Middle Aged
Network analysis
Oncology
Population
Radiology
Remote sensing
Rural areas
Rural environments
Rural Population
Rural populations
rural‐urban
Spatial analysis
United States - epidemiology
Urban areas
Urban environments
Urban Population
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Summary:Background Although recommended lung cancer screening with low‐dose computed tomography scanning (LDCT) reduces mortality among high‐risk adults, annual screening rates remain low. This study complements a previous nationwide assessment of access to lung cancer screening within 40 miles by evaluating differences in accessibility across rural and urban settings for the population aged 50 to 80 years and a subset eligible population based on the 2021 US Preventive Services Task Force LDCT lung screening recommendations. Methods Distances from population centers to screening facilities (American College of Radiology Lung Cancer Screening Registry) were calculated, and the number of individuals who had access within graduating distances, including 10, 20, 40, 50, and 100 miles, were estimated. Census tract results were aggregated to counties, and both geographies were classified with rural‐urban schemas. Results Approximately 5% of the eligible population did not have access to lung cancer screening facilities within 40 miles; however, different patterns of accessibility were observed at different distances, between regions, and across rural‐urban environments. Across all distances and geographies, there was a larger percentage of the population in rural geographies with no access. Although the rural population represented approximately 8% of the eligible population, the larger percentage of the rural population with no access was noteworthy and translated into a larger number of individuals with no access at longer distance thresholds (≥40 miles). Conclusions Disparities in access should be examined as both percentages of the population and numbers of individuals with no access in order to tailor interventions to communities and increase access. Geospatial analysis at the census tract level is recommended to help to identify optimal focus areas and reach the most people. Lay Summary As annual lung cancer screening rates remain low, this study examines access to lung cancer screening nationwide and across rural and urban settings. A geographic information system network analysis of census tract–level populations is used to estimate access at different distances, including 10, 20, 40, 50, and 100 miles, and the results are aggregated to counties. Approximately 5% of the eligible population does not have access to screening facilities within 40 miles; however, different patterns of accessibility are observed at different distances, between regions, and across ru
ISSN:0008-543X
1097-0142
DOI:10.1002/cncr.33996