Lucy B Spalluto1, Jennifer A Lewis2, Lauren R Samuels3, Carol Callaway-Lane4, Michael E Matheny5, Jason Denton6, Jennifer A Robles7, Robert S Dittus8, David F Yankelevitz9, Claudia I Henschke10, Pierre P Massion11, Drew Moghanaki12, Christianne L Roumie13. 1. Veterans Health Administration - Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center, Nashville, Tennessee; Vice-Chair of Health Equity, Associate Director of Diversity and Inclusion, and Director of Women in Radiology, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center Nashville, Tennessee; and Immediate Past-President, American Association for Women in Radiology; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee. Electronic address: lucy.b.spalluto@vumc.org. 2. Veterans Health Administration - Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Co-Director, VA Tennessee Valley Healthcare System Lung Cancer Screening Program, Nashville, Tennessee; and Board member, Rescue Lung Rescue Life Society; Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee. 3. Veterans Health Administration - Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center, Nashville, Tennessee; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee. 4. Veterans Health Administration - Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center, Nashville, Tennessee; Co-Director, VA Tennessee Valley Healthcare System Lung Cancer Screening Program, Veterans Health Administration. 5. Veterans Health Administration - Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Co-Director, Center for Improving the Publics' Health Through Informatics; Associate Director, VA Advanced Fellowship in Medical Informatics, VA Tennessee Valley Healthcare System; Associate Director, VINCI Resource Center, VACO Office of Research & Development. 6. Veterans Health Administration - Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee. 7. Veterans Health Administration - Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center, Nashville, Tennessee; Veterans Health Administration - Tennessee Valley Healthcare System, Surgery Service, Nashville, Tennessee; Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee. 8. Veterans Health Administration - Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee. 9. Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York. 10. Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York; Phoenix Veterans Health Care System, Phoenix, Arizona. 11. Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Veterans Health Administration - Tennessee Valley Healthcare System, Medical Service, Nashville, Tennessee. 12. Radiation Oncology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, California; Chief of Thoracic Oncology Service, Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California; Director, VA Partnership to Increase Access to Lung Screening; and Co-Chair, VA CSP #2005 VA Surgery or Stereotactic Radiotherapy for Lung Cancer Trial. 13. Veterans Health Administration - Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Deputy Director, Quality Scholars Program, VA Tennessee Valley Healthcare System; and Director, Vanderbilt University School of Medicine Mater of Public Health Program.
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. Published by Elsevier Inc.
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. Published by Elsevier Inc.
Entities:
Keywords:
Lung cancer screening; Veterans; Veterans Health Administration; lung cancer; rural
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