Study Reveals Racial Inequities in Lung Cancer Screening Among Veterans

Neelima Navuluri, MD, MPH

Credit: Duke University

A new study conducted at the Durham Veterans Affairs Health Care System (DVAHCS) exposed the racial disparities in lung cancer screening. Results showed veterans who are Black had lower rates of completing the screening process for lung cancer when compared with White veterans, even after accounting for various demographic and socioeconomic risk factors.¹

Lung cancer is a leading cause of cancer-related mortality worldwide, and early detection through lung cancer screening has been shown to improve patient outcomes, according to the study. Understanding these disparities is crucial for developing targeted interventions to improve screening rates and reduce health inequities.²

The evidence observed by Neelima Navuluri, MD, MPH, Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Duke University School of Medicine, and investigators, showed significantly lower screening rates which suggested the existence of unaddressed barriers.¹

The cross-sectional study aimed to investigate whether racial disparities exist in completing lung cancer screening among veterans after adjusting for various demographic and socioeconomic risk factors.

Included were 4562 veterans referred for screening between July 2013 - August 2021, at the DVAHCS. All participating patients self-identified as either White or Black and met the eligibility criteria set by the US Preventive Services Task Force.

Veterans who died within 15 months of consultation or who were screened before consultation were excluded from the analysis.

The investigation’s primary outcome measure was screening completion, defined as completing computed tomography for lung cancer screening. Logistic regression models were employed to analyze the associations among screening completion, race, and demographic and socioeconomic risk factors.

Among the veterans referred for screening, only 37.1% (n = 1692) completed it. The study population age averaged at 65.4 years, with 94.2% being male. Of the total sample, 38.7% identified as Black, while 61.3% identified as white. Black veterans had substantially lower screening rates compared with white veterans, with only 538 (30.5%) of Black veterans completing screening, compared with 1154 (41.3%) of white veterans.

After adjusting for various demographic and socioeconomic factors, Black veterans still had 34% lower odds of completing the screening process for lung cancer, as compared with white veterans (OR: 0.66, 95% CI: 0.54 - 0.80).

These findings indicated racial disparities in LCS rates cannot be fully explained by demographic and socioeconomic variables alone, according to the data.

Even despite the presence of a centralized lung cancer screening program within the Veterans Affairs system, Black veterans had significantly lower odds of completing the screening compared with White veterans. Investigators noted this disparity persisted even after adjusting for various demographic and socioeconomic risk factors, therefore additional factors contribute to the lower screening rates.

Furthermore, the study acknowledged the need for further qualitative research to identify the understanding of the specific barriers faced by Black veterans in accessing and completing this screening, stressing the necessity of exploring the factors that impede the connection between this population and the screening program after referral.

Evidence-based interventions targeted specifically at improving lung cancer screening rates among Black veterans are crucial, investigators wrote. Interventions should address both systemic barriers and individual-level factors, including promoting awareness and education about the benefits of lung cancer screening, ensuring equitable access to screening services, and fostering culturally competent care.

References:

1. Navuluri N, Morrison S, Green CL, et al. Racial Disparities in Lung Cancer Screening Among Veterans, 2013 to 2021. JAMA Netw Open. 2023;6(6):e2318795. doi:10.1001/jamanetworkopen.2023.18795
2. Grossi G. Panagis Galiatsatos, MD: Evolving Screening Strategies for Lung Cancer. HCPLive. May 25, 2023. https://www.hcplive.com/view/panagis-galiatsatos-evolving-screening-strategies-lung-cancer