Study Finds Rural Residence May Adversely Influence Lung Cancer Screening Among Veterans

Veterans residing in rural areas are less likely to complete annual repeat lung cancer screening compared with those living in a nonrural location, according to study findings published in Journal of the American College of Radiology.

As the leading cause of cancer-related death in the United States, lung cancer incidence , mortality rates, and advanced stage disease rates have been shown to be higher among those who live in rural areas.

Although use of low-dose CT (LDCT) screening offers an opportunity to detect early-stage lung cancer and lead to improved survival outcomes, the researchers of the present study note that lifesaving benefits occur with consistent annual repeat screening.

“Known disparities in lung cancer outcomes between rural and nonrural populations may be in part because of barriers rural populations face in obtaining cancer care and to the higher proportion of smokers in rural areas,” said the study authors. “Veterans face additional barriers to care, such as a limited access to affordable and convenient health care, concerns about social exclusion and stigma, and unmet basic needs for self and family, that may prevent them from pursuing health-seeking behavior such as lung cancer screening.”

They sought to investigate rates of annual repeat LDCT lung cancer screening among rural and nonrural veterans who had undergone initial screening, hypothesizing that rural residents would be less likely to report repeated adherence.

Utilizing data from the national Veterans Health Administration Observational Medical Outcomes Partnership data set, 11,402 veterans who underwent LDCT for lung cancer screening at Veterans Affairs medical centers between 2015 and 2019 were included in the retrospective cohort study.

“The primary outcome was a 1-year annual repeat LDCT after initial LDCT lung cancer screening, defined as documentation of LDCT lung cancer screening between 9 and 15 months after initial LDCT lung cancer screening,” explained the researchers. “A sensitivity analysis expanded the window for repeat LDCT lung cancer screening to between 31 days and 18 months after initial LDCT lung cancer screening, which is also used by investigators.”

Rural status was defined using rural-urban commuting area codes, in which 2316 (mean [SD] age, 66.6 [5.4] years; 95.8% male; 87.6% White) and 9086 (mean [SD] age, 66.1 [5.5] years; 95.4% male; 64.1% White) participants lived in rural and nonrural areas, respectively. Multivariable logistic regression models were used to examine rurality as a predictor of annual repeat lung cancer screening.

Findings of the primary analysis showed numerically lower odds of annual repeat lung cancer screening among veterans residing in rural vs nonrural locations (27% vs 31.8%; adjusted OR [aOR], 0.86; 95% CI, 0.73-1.03).

Similar results were also seen in the sensitivity analysis, with veterans of rural vs nonrural residences associated with lower odds of annual repeat lung cancer screening in the expanded 31-day to 18-month window (41.6% vs 45.2%; aOR, 0.88; 95% CI, 0.73-1.04).

Subset analyses of participants 65 years and older and those younger than 65 years additionally showed lower odds of annual repeat lung cancer screening between rural vs nonrural areas for both age groups (≥ 65 years: aOR, 0.83; 95% CI, 0.71-0.98; < 65 years: aOR, 0.93; 95% CI, 0.77-1.12).

Further findings of an exploratory analysis evaluating the association of rurality with initial lung cancer screening showed that only 0.6% of eligible rural veterans (545 of 91,786) underwent an initial lung cancer screening compared with 3.5% of nonrural veterans (2138 of 61,937). Rural veterans eligible for lung cancer screening were associated with 83% lower odds (OR, 0.17; 95% CI, 0.15-0.18) of undergoing initial LDCT lung cancer screening vs nonrural veterans.

“Continued, intentional outreach efforts to increase annual repeat lung cancer screening among rural veterans may offer an opportunity to decrease deaths from lung cancer,” concluded the study authors.

Reference

Spalluto LB, Lewis JA, Samuels LR, et al. Association of rurality with annual repeat lung cancer screening in the Veterans Health Administration. J Am Coll Radiol. 2022 Jan;19(1 Pt B):131-138. doi:10.1016/j.jacr.2021.08.027