Study Evaluates Disparities in Opportunities for Lung Cancer Screening

Further efforts to improve electronic health record (EHR) documentation of smoking history are “essential” to mitigate disparities in lung cancer screening, according to research presented at the American Thoracic Society 2024 International Conference.

Lori Sakoda, MPH, PhD, of the Division of Research at Kaiser Permanente Northern California and the Kaiser Permanente Bernard J. Tyson School of Medicine, and colleagues conducted the study because “evidence suggests that lung cancer screening with low-dose computed tomography is currently underutilized and not being offered equitably to eligible adults in the United States.” However, the “extent and determinants” of racial and ethnic disparities in lung cancer screening, including the opportunity to receive screening, are “largely unknown,” according to Dr. Sakoda and colleagues.

The researchers evaluated the opportunity to be screened for lung cancer in a population of over 1.4 million adults ages 50 to 80 years from an integrated health care system in Northern California. The opportunity to be screened for lung cancer was measured by the completeness of EHR documentation on smoking history to assess lung cancer screening eligibility based on the 2021 US Preventive Services Task Force recommendations, overall and by race and ethnicity. Dr. Sakoda and colleagues calculated the proportion of adults with complete smoking history documentation for each 6-month interval from July 2014 to December 2022 to examine temporal changes.

The study showed that the proportion of people with complete EHR documentation on smoking history to assess lung cancer screening eligibility increased from 71.7% to 76.2% overall, for an increase of 4.5%.

The researchers broke down the changes in the proportion of people with complete EHR documentation on smoking history to assess lung cancer screening eligibility by race:

• Native American adults: 68.4% to 74.9%, an increase of 6.5%
• Black adults: 69.0% to 75.7%, an increase of 6.7%
• Hispanic adults: 71.6% to 77.3%, an increase of 5.7%
• White adults: 71.7% to 77.1%, an increase of 5.4%
• Asian adults: 77.0% to 81.6%, an increase of 4.6%
• Multi-race adults: 77.4% to 82.1%, an increase of 4.7%

Dr. Sakoda and colleagues explained that “although the absolute change in complete smoking history documentation was highest for Black and Native American adults, the proportion of Black and Native American adults with complete smoking history documentation was consistently lower over time compared [with] the other groups.”

For example, after full covariate adjustment, the odds of complete smoking history documentation remained lower for Black (odds ratio [OR], 0.98; 95% CI, 0.96-0.99) and Native American (OR, 0.93; 95% CI, 0.88-0.99) adults, relative to White adults. The odds of complete smoking history documentation were higher for Asian (OR, 1.38; 95% CI,1.36-1.39), Hispanic (OR, 1.16; 95% CI, 1.15-1.18), and multi-race (OR, 1.23; 95% CI, 1.19-1.26) adults, relative to White adults, after full covariate adjustment.

“Our data suggest that racial and ethnic disparities exist in the opportunity to be screened for lung cancer, which remain unexplained by prior health care utilization or other individual-level factors,” Dr. Sakoda and colleagues concluded. “To mitigate disparities in [lung cancer screening], further efforts to improve EHR documentation of smoking history are essential.”

Reference

Sakoda LC, Zhu Z, Young-Wolff KC, et al. Extent and determinants of racial and ethnic disparities in the opportunity to undergo lung cancer screening. Presented at the American Thoracic Society 2024 International Conference; May 17-22, 2024; San Diego, California.