Black patients face 34% lower odds of completing lung cancer screening after a referral

Black patients are 34% less likely to complete lung cancer screening after a referral when compared to their white counterparts, according to an analysis of data from Veterans Affairs.

The disparity persisted even after adjusting for demographic and socioeconomic factors such as distance to the scanner, employment status and current smoking status. Experts believe these findings offer key clues as providers seek to design programs that reach as many patients as possible.

“A critical point in the screening process was when veterans must connect with the screening program after referral,” Neelima Navuluri, MD, with the Duke University School of Medicine, and co-authors wrote June 16 in JAMA Network Open [1]. “These findings may be used to design, implement, and evaluate interventions to improve LCS rates among Black veterans.”

For the study, researchers assessed data for all individuals referred for screening at the Durham Veterans Affairs Health Care System between 2013 to 2021. The final sample included 4,562 veterans at an average age of 65, about 61% of whom were white and 39% Black. Of all veterans referred, 37% ultimately completed screening versus 59% who never connected with the program following a referral, informational mailer or telephone call. This indicated a “critical point in the LCS process,” the authors noted.

Rates were substantially lower among Black patients—30.5% compared to 41% among white veterans. Risk factors for lower odds of screening completion among Black vets included age, marital status and current smoking status. Meanwhile, pack-year history, combat veteran status and care assessment needs were tied to higher odds of screening completion. 

“Despite an overall screening rate that is much higher than in a study using Behavioral Risk Factor Surveillance System annual surveys (37.1% vs 17%), we report a similar racial disparity in LCS completion rates after accounting for various sociodemographic and clinical factors,” the authors noted. “This finding suggests that even though center characteristics, such as a centralized screening process or cost mitigation associated with a single-payer health system, may improve LCS rates overall, there are still racial disparities in LCS.”

Digging deeper into the data, age at referral was found to be the only variable affecting a patient’s chance of completing screening. Veterans in older age categories (both in the total cohort and Black subgroup) had lower odds of screening completion compared to those younger than 60.

“Potential reasons for this finding may include personal factors regarding attitudes around screening or cancer diagnosis, as well as practitioner factors around utility of screening and life expectancy,” the authors noted.

Read more, including potential study limitations, at the link below.