Low likelihood for undergoing lung cancer screening after referral among Black veterans
Click Here to Manage Email Alerts
Key takeaways:
- More white vs. Black veterans got screened for lung cancer after receiving a referral.
- For Black veterans, being 60 years or older, not married and smoking were each linked to reduced odds for getting screened.
Compared with white veterans, Black veterans had a reduced likelihood of carrying out a lung cancer screening referral, according to study results published in JAMA Network Open.
“Racial disparities in lung cancer screening have been previously described and are frequently attributed to financial factors such as cost or insurance status, as well as poor access to care or transportation,” Neelima Navuluri, MD, MPH, assistant professor of medicine in the division of pulmonary, allergy and critical care at Duke University School of Medicine, told Healio. “This study showed that racial disparities also exist within the VA, a health care system where these barriers are attenuated.”
In a retrospective cross-sectional study, Navuluri and colleagues analyzed 4,562 veterans (mean age, 65.4 years; 94.2% men; 38.7% Black) from the Durham Veterans Affairs Health Care System who received a lung cancer screening referral between July 2013 and August 2021 to see if racial disparities are present in getting a CT screening.
Through logistic regression models, researchers evaluated how screening completion was linked to race and various demographic and socioeconomic risk factors.
From the total cohort, 1,692 (37.1%) veterans underwent CT screening, whereas 2,707 (59.3%) did not reach out to the lung cancer screening program even after receiving an informational mailer and phone call. A little more than one-third of veterans (38.3%) agreed to screening, and 2.4% declined it, according to researchers.
“This study showed that a critical point where the gap in screening uptake occurs after referral is when veterans must connect with the screening program to document a shared decision-making conversation and have the CT ordered,” Navuluri told Healio.
Researchers observed that a greater proportion of white veterans vs. Black veterans completed the screening (41.3% vs. 30.5%).
Adjusting for age, smoking status, pack-year history and socioeconomic factors further showed reduced odds for carrying out lung cancer screening among Black veterans (aOR = 0.66; 95% CI, 0.54-0.8).
Additionally, odds for Black veterans completing screening within 180 days were similar to those observed in the adjusted analysis (OR = 0.64; 95% CI, 0.56-0.73).
When assessing the factors linked to screening completion among both white and Black veterans in multivariable analysis, researchers found reduced odds for getting screened for lung cancer when the veteran had a mental health or substance use diagnosis (adjusted OR = 0.86; 95% CI, 0.75-0.99), were either aged 70 to 75 years (aOR = 0.43; 95% CI, 0.34-0.55) or older than 75 years (aOR = 0.39; 95% CI, 0.26-0.59) and reported current smoking (aOR = 0.76; 95% CI, 0.66-0.87).
On the other hand, greater odds for getting screened were found to be linked to several different factors: increased Care Assessment Need (CAN) score (aOR = 1.04 per 5 units; 95% CI, 1.02-1.06), combat veteran status (aOR = 1.26; 95% CI, 1-1.59), retired employment status (aOR = 1.3; 95% CI, 1.05-1.6), service connection of 50% to 100% (aOR = 1.38; 95% CI, 1.17-1.61) and increased pack-year history (aOR = 1.02 per 5 years; 95% CI, 1.01-1.04).
For Black veterans, odds for undergoing screening were low when they were aged 60 years or older (60-65 years, aOR = 0.67; 95% CI, 0.5-0.88; 65-70 years, aOR = 0.65; 95% CI, 0.48-0.88; 70-75 years, aOR = 0.37; 95% CI, 0.25-0.55; > 75 years, aOR = 0.46; 95% CI, 0.23-0.91), not married (aOR = 0.7; 95% CI, 0.5-0.98) and reported current smoking (aOR = 0.8; 95% CI, 0.64-1.01).
Factors associated with increased odds of participating in lung cancer screening among Black veterans included a higher CAN score (aOR = 1.03 per 5 units; 95% CI, 1.01-1.06) combat veteran status (aOR = 1.88; 95% CI, 1.27-2.77) and higher pack-year history (aOR = 1.03 per 5 years; 95% CI, 0.99-1.06).
“The study underscores that there are multiple varied factors which influence racial disparities in screening. These must be better understood through further quantitative and qualitative work,” Navuluri told Healio.
“Future studies should focus on assessing interventions which address social determinants of health and/or shared decision making to improve disparities in lung cancer screening,” she added.
For more information:
Neelima Navuluri, MD, MPH, can be reached at neelima.navuluri@duke.edu.