Lung cancer screening completion rates and neighborhood disadvantage among primary care patients in an integrated delivery network health system: a retrospective data analysis

BACKGROUND: In the United States, lung cancer screening (LCS) via low-dose computed tomography is recommended for adults at high risk, but LCS uptake is poor, particularly among patients with lower socioeconomic status (SES). We evaluated neighborhood disadvantage, a measure of SES, as a predictor of LCS completion rates among primary care patients seen in the Washington, D.C. and Maryland area to understand how neighborhood disadvantage may impact LCS completion. METHODS: Utilizing electronic health record data, we calculated LCS completion rates in the past 12 months among patients who received an LCS order (N = 829) to a hybrid LCS program between September 2022 and August 2023 at 51 primary care clinics. To measure neighborhood disadvantage, we used the census block level Area Deprivation Index (ADI), a composite index of demographic and socioeconomic variables. The state-specific ADI decile is ranked on a scale of 1 to 10, with a higher score reflecting greater neighborhood disadvantage. A logistic regression model with generalized estimating equations (GEE) assessed the association of ADI with LCS completion, controlling for race, smoking status, minutes required to travel to the nearest LCS screening location, and clinic type. RESULTS: Most potentially eligible patients who received a LCS order (766, 92.4%) had a standardized address that could be linked to ADI data. The mean age was 66 (standard deviation = 7) years, 35% were Black or African-American, and 65% were currently smoking. Among patients ordered an LCS, the overall completion rate was 24%. The ADI was inversely associated with LCS completion: a one decile increase in ADI corresponded to significantly lower odds of completing LCS (odds ratio = 0.91, 95% confidence interval: 0.86-0.97). CONCLUSIONS: In a large, socioeconomically diverse health system, higher neighborhood disadvantage was associated with lower completion among patients ordered an LCS. While a LCS order is necessary to access LCS, strategies that consider neighborhood context are needed to increase successful completion of LCS among lower SES groups. Primary care practices may be an effective setting for these strategies due to their focus on cancer screenings and role as often being the first point of contact for LCS. This study was approved by the Georgetown-MedStar Institutional Review Board (STUDY00009269).