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. 2022 Jan;19(1 Pt B):131-138.
doi: 10.1016/j.jacr.2021.08.027.

Association of Rurality With Annual Repeat Lung Cancer Screening in the Veterans Health Administration

Lucy B Spalluto  1 , Jennifer A Lewis  2 , Lauren R Samuels  3 , Carol Callaway-Lane  4 , Michael E Matheny  5 , Jason Denton  6 , Jennifer A Robles  7 , Robert S Dittus  8 , David F Yankelevitz  9 , Claudia I Henschke  10 , Pierre P Massion  11 , Drew Moghanaki  12 , Christianne L Roumie  13
Affiliations

Association of Rurality With Annual Repeat Lung Cancer Screening in the Veterans Health Administration

Lucy B Spalluto et al. J Am Coll Radiol. 2022 Jan.

Abstract

Purpose: Lung cancer causes the largest number of cancer-related deaths in the United States. Lung cancer incidence rates, mortality rates, and rates of advanced stage disease are higher among those who live in rural areas. Known disparities in lung cancer outcomes between rural and nonrural populations may be in part because of barriers faced by rural populations. The authors tested the hypothesis that among Veterans who receive initial lung cancer screening, rural Veterans would be less likely to complete annual repeat screening than nonrural Veterans.

Methods: A retrospective cohort study was conducted of 10 Veterans Affairs medical centers from 2015 to 2019. Rural and nonrural Veterans undergoing lung cancer screening were identified. Rural status was defined using the rural-urban commuting area codes. The primary outcome was annual repeat lung cancer screening in the 9- to 15-month window (primary analysis) and 31-day to 18-month window (sensitivity analysis) after the first documented lung cancer screening. To examine rurality as a predictor of annual repeat lung cancer screening, multivariable logistic regression models were used.

Results: In the final analytic sample of 11,402 Veterans, annual repeat lung cancer screening occurred in 27.7% of rural Veterans (641 of 2,316) and 31.8% of nonrural Veterans (2,891 of 9,086) (adjusted odds ratio: 0.86; 95% confidence interval: 0.73-1.03). Similar results were seen in the sensitivity analysis, with 41.6% of rural Veterans (963 of 2,316) versus 45.2% of nonrural Veterans (4,110 of 9,086) (adjusted odds ratio: 0.88; 95% confidence interval: 0.73-1.04) having annual repeat screening in the expanded 31-day to 18-month window.

Conclusions: Among a national cohort of Veterans, rural residence was associated with numerically lower odds of annual repeat lung cancer screening than nonrural residence. Continued, intentional outreach efforts to increase annual repeat lung cancer screening among rural Veterans may offer an opportunity to decrease deaths from lung cancer.

Keywords: Lung cancer screening; Veterans; Veterans Health Administration; lung cancer; rural.

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Conflict of interest statement

Conflict of Interest:

LBS, JAL, and CCL serve on the Steering Committee for this VAMC lung screening program. JAL and CCL are clinical co-directors of the clinical lung cancer screening program. Neither receive financial compensation for these roles.

DFY is a named inventor on a number of patents and patent applications relating to the evaluation of diseases of the chest including measurement of nodules. Some of these, which are owned by Cornell Research Foundation (CRF), are non-exclusively licensed to General Electric. As an inventor of these patents, DFY is entitled to a share of any compensation which CRF may receive from its commercialization of these patents. He is also an equity owner in Accumetra, a privately held technology company committed to improving the science and practice of image-based decision making. DFY also serves on the advisory board of GRAIL.

CIH is the President and serves on the board of the Early Diagnosis and Treatment Research Foundation. She receives no compensation from the Foundation. The Foundation is established to provide grants for projects, conferences, and public databases for research on early diagnosis and treatment of diseases. CIH is also a named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on CT scans of the chest which are owned by Cornell Research Foundation (CRF). Since 2009, CIH does not accept any financial benefit from these patents including royalties and any other proceeds related to the patents or patent applications owned by CRF.

Figures

Figure 1.
Figure 1.
Study Cohort.
See this image and copyright information in PMC

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