Socioeconomic Disparities in Lung Cancer Screening Participation

Importance: Lung cancer screening in high-risk populations reduces mortality, yet the effectiveness of a national screening program depends on equitable participation across socioeconomic and demographic groups. Objective: To investigate whether sociodemographic and socioeconomic factors are associated with participation across stages in a risk-based lung cancer screening pilot program in Sweden. Design, Setting, and Participants: Registry-linked cohort study conducted between September 2022 and May 2024. Participants were women aged 55 to 74 years residing in Region Stockholm, Sweden, who were invited to participate in a pilot program for risk-based lung cancer screening. Exposures: Sociodemographic and socioeconomic factors, including educational level, income, region of origin, and area-level living conditions. Main Outcomes and Measures: Three binary outcomes were examined across sequential stages of the screening pathway: (1) participation in the initial risk-assessment questionnaire, (2) meeting eligibility criteria for low-dose computed tomography (LDCT) screening, and (3) attendance at the LDCT examination among eligible women. Results: Of 34 592 invited women (mean [SD] age, 63.2 [5.6] years), 11 509 (33.3%) completed the questionnaire, 1104 (9.6%) met eligibility criteria, and 980 (88.8%) attended baseline LDCT. Participation in the initial questionnaire was higher among women with higher education (risk ratio [RR], 1.71; 95% CI, 1.59-1.84), higher income (RR, 1.72; 95% CI, 1.64-1.81), and residence in areas with favorable living conditions (RR, 1.59; 95% CI, 1.42-1.79). Conversely, women with higher income (RR, 0.64; 95% CI, 0.54-0.77) and education (RR, 0.38; 95% CI, 0.31-0.46) and those living in socioeconomically advantaged areas (RR, 0.55; 95% CI, 0.43-0.72) were less likely to meet the eligibility criteria for screening with LDCT. Among eligible women, attendance at the LDCT examination was largely equitable, with only minor differences by region of origin. Conclusions and Relevance: In this cohort study, attendance among eligible women was equitable regardless of sociodemographic and socioeconomic profile. However, participation in the initial risk-selection stage was socioeconomically patterned, suggesting that the design of the risk-assessment approach is critical for ensuring equitable access and inclusion of socioeconomically disadvantaged groups in a future national lung cancer screening program.