Abstract B148: Association of coronary artery calcification found on lung cancer screening exam and all-cause mortality in patients at a large metropolitan health system

Abstract Background: Lung cancer screening (LCS) with low dose computed tomography (LDCT) can detect lung cancer at earlier stages and reduce mortality. Coronary artery calcification (CAC) is a common incidental finding among patients undergoing LDCT for LCS. Although CAC is a known risk factor for coronary heart disease, it remains unclear whether CAC identified on LCS is associated with mortality risk and if so, whether associations differ by race. Objective: We examined the association between moderate to severe CAC and all-cause mortality among patients undergoing LDCT for LCS and assessed differences by race. Methods: We conducted a retrospective analysis of electronic health records (EHR) from Henry Ford Health (2016-2023) among patients undergoing LDCT for LCS with follow-up through December 31, 2024. CAC was classified as moderate or severe (vs. none or mild). We focused on Black and White patients, given the small sample size in the other racial and ethnic groups. All-cause mortality was assessed using State of Michigan death data. Cox proportional hazard regression was used to examine the association between moderate to severe CAC and mortality, adjusting for age, sex, race, marital status, smoking status, Body Mass Index (BMI), and Charlson Comorbidity Index (CCI). Stratified analysis was conducted by race. Results: A total of 17,587 unique patients who were eligible for LCS and completed their baseline (first) lung screening CT during the study period were included. Of these, 80% were White and 20% were Black. The mean age of patients was 63.9±5.8 years; 51% were male, 62% reported current tobacco smoking and 20% of the patients had CCI score of 1. The mean BMI was 29.4 ± 6.8 kg/m2. The prevalence of moderate to severe CAC was 14% overall and was significantly higher among Black vs White patients (17% vs 13%, p<0.0001). In unadjusted models, moderate to severe CAC was associated with a 1.5-fold increased hazard of all-cause mortality (hazard ratio [HR] 1.5; 95% confidence interval [CI], 1.3–1.7). This association was attenuated and no longer statistically significant after adjusting for confounders (HR 1.1; 95% CI, 0.9–1.3). However, in race-stratified analyses, moderate to severe CAC remained significantly associated with higher mortality among Black patients even after adjustment (HR 1.4; 95% CI, 1.1–1.9). In contrast, among White patients, the adjusted association was not statistically significant (HR 1.0; 95% CI, 0.8–1.3). Conclusion: Findings suggest a higher prevalence of moderate to severe CAC among Black compared to White patients in the LCS setting. Moderate to severe CAC was associated with increased risk of all-cause mortality among Black patients after adjusting for clinical and demographic factors. These results highlight the potential utility of incorporating CAC assessment into LCS programs particularly for Black patients, who exhibit both higher CAC prevalence and greater mortality risk. Citation Format: Dakshu Jindal, Kelly A. Hirko, Sunita Ghosh, Thomas Song, Andrea E. Cassidy-Bushrow, Katie A. Latack, Punith Shetty, Laura L. Susick, Avi Cohen, Mike Simoff, Christine Neslund-Dudas. Association of coronary artery calcification found on lung cancer screening exam and all-cause mortality in patients at a large metropolitan health system [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B148.