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Chest. 2018 Nov 9. pii: S0012-3692(18)32720-X. doi: 10.1016/j.chest.2018.10.039. [Epub ahead of print]

The Landscape of US Lung Cancer Screening Services.

Author information

1
Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
2
Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
3
Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
4
Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: bian.liu@mountsinai.org.

Abstract

BACKGROUND:

Low adoption of lung cancer screening is potentially caused by inadequate access to a comprehensive lung cancer screening registry (LCSR), currently a requirement for reimbursement by the Centers for Medicare and Medicaid Services. However, variations in LCSR facilities have not been extensively studied.

METHODS:

We applied a hierarchical clustering method to a comprehensive database integrating state-level LCSR facility density, defined as the number of facilities per 100,000 at-risk persons, lung cancer outcomes including mortality and stage-specific incidence, and socioeconomic and behavioral factors.

RESULTS:

We found three distinct clusters of LCSR facilities roughly corresponding to the northern (cluster 1), southeastern (cluster 2), and southwestern (cluster 3) states. The southeastern states had the lowest total number of facilities (67 ± 44 in cluster 2 < 74 ± 69 in cluster 1 < 80 ± 100 in cluster 3), the slowest increase in facilities (23 ± 20 in cluster 2 < 26 ± 28 in cluster 1 < 27 ± 32 in cluster 3) between 2016 and 2018, and the highest lung cancer burden and current smokers. They ranked second in terms of facility density (2.9 ± 1.0 in cluster 3 < 3.8 ± 1.3 in cluster 2 < 6.3 ± 2.8 in cluster 1) and increase in facility density (1.1 ± 0.3 in cluster 3 < 1.3 ± 0.7 in cluster 2 < 2.5 ± 2.5 in cluster 1).

CONCLUSIONS:

We found substantial state-level variability in LCSR facilities tied to lung cancer burden, socioeconomic characteristics, and behavioral characteristics. Given the known risk factors of lung cancer, correcting a suboptimal distribution of screening programs will likely lead to improved lung cancer outcomes.

KEYWORDS:

Medicare; geographic disparities; health service access; lung cancer screening; registry

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