Abstract | December 20, 2022
Socioeconomic Patterns of Lung Nodule Referral and Management in a Minority-Predominant Community
Learning Objectives
- Understand current socioeconomic patterns in lung cancer screening.
- Appreciate the underutilization of lung cancer screening on a national scale.
- Aspire to provide better access to lung cancer screening for minority patients, patients from lower SES, and those with limited health literacy.
Background: Lung cancer is the leading cause of malignancy-related deaths in the United States, yet lung cancer screening rates have been consistently lower than 5% for all patients who qualify according to the USTSPF guidelines. It is imperative to understand socioeconomic patterns in lung nodule referral and management to improve the equity of healthcare delivery, especially among minority and underserved communities.
Methods: This is a retrospective analysis performed at a pulmonology clinic serving a unique, minority-predominant community. Patient demographics and medical history were collected. The primary outcome measured was the time interval from referral to the initial clinic visit. Other outcomes measured include lung nodule size changes, diagnosis, and final patient disposition. Statistical analysis was performed with IBM-SPSS 27.
Results: A total of 157 patients referred for new lung nodules were included (45.2% Male, 43.9% African American, average age= 63 years). Across all studied patients, the average time interval from referral to initial clinic visit was 26.6 days. Despite minor variations, this referral-to-clinic interval did not differ significantly across socioeconomic cohorts as stratified by race, insurance status, education level, or patients’ location of residence. Albeit there was a non-significant trend for African American patients experiencing longer referral intervals than their Caucasian counterparts (29.2 days vs. 24.2 days, respectively, p=0.154). Similarly, there were trends showing Medicaid patients and patients with lower education levels experiencing longer referral intervals than their peers. Additionally, Medicaid patients, patients with lower education levels, and patients residing in underprivileged neighborhoods showed a trend towards lower rates of continued CT surveillance compared to those of peer groups.
Conclusion: At a pulmonology clinic serving a unique, minority-predominant community, patients’ race, insurance status, education level, or location of residence did not significantly affect the timeline or disposition of lung nodule management, though some notable trends were observed. The uniqueness of such findings can partly be attributed to the distinct demographic makeup of our minority-majority patient population and the diverse ethnic backgrounds of our clinical staff. Further work is needed to improve national equity in lung cancer screening.
References:
- Lewis et al, JNCI, 2020.
- Zahnd et al, Am J Prev Med, 2019.
