Patients with high distressed communities index score are at risk for “no-show” to lung cancer screening appointments

Randomized data support the mortality benefit of lung cancer screening; however, completion rates among those meeting eligibility criteria remain concerningly low. The Distressed Communities Index is a composite socioeconomic metric assessed by zip code. We sought to investigate the association between DCI and completion of scheduled lung cancer screening appointments. A retrospective study was conducted for patients scheduled for lung cancer screening with low-dose computed tomography at a high-volume center in 2021. Patients were marked as a "no-show" when they missed or canceled their scheduled screening appointment. The association between DCI and screening no-show rates was modeled using a stepwise approach. A total of 1,114 patients were scheduled for lung cancer screening, of whom 83.5% (n=928) resided in zip codes that are considered "at-risk" or "distressed" in terms of socioeconomic distress based on their DCI score. Within the entire cohort, 18.4% (n=205) did not attend any screening appointments scheduled within the year. Patients in the "at-risk" and "distressed" categories were more likely to no-show at their appointments (19.5% vs. 12%, p=0.015). A higher DCI score was associated with increased probability of screening non-completion on univariable analysis (OR 1.02, 95%CI 1.01-1.03; p-value=0.002). On multivariable analysis, additional factors associated with higher likelihood to no-show included current smoking status (aOR 2.59, 95%CI 1.70-3.96) and initial screening (aOR 2.07, 95%CI 1.43-3.00). Higher DCI scores are associated with increased no-show rates for lung cancer screening appointments. This tool can be used to target populations at risk of underscreening and associated lung cancer mortality with navigational support or novel interventions to increase screening.