National Lung Cancer Screening Utilization Trends in the Veterans Health Administration
National Lung Cancer Screening Utilization Trends in the Veterans Health Administration
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DOI：
10.1093/jncics/pkaa053
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发表时间：
2020-10-01
影响因子：
4.4
通讯作者：
Roumie, Christianne L.
中科院分区：
文献类型：
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作者：
Lewis, Jennifer A.;Samuels, Lauren R.;Roumie, Christianne L.
背景：许多退伍军人患肺癌的风险很高。低剂量计算机断层扫描（LDCT）是高危人群早期发现肺癌的有效策略。我们的目标是描述和比较退伍军人健康管理局 (VHA) LDCT 筛查的年度和地理利用趋势。方法：使用 2011 年 1 月 1 日至 2018 年 5 月 31 日筛选的全国退伍军人回顾性队列来计算每 1000 名符合条件的退伍军人的年度和区域初始 LDCT 使用率。我们使用通用程序术语代码 G0297 或 71250 确定了进行第一次 LDCT 检查的退伍军人，并将其描述为“肺癌筛查”、“筛查”或“LCS”。每年符合筛查资格的退伍军人人数按当年在退伍军人事务医疗中心 (VAMC) 就诊的 55 至 80 岁的唯一退伍军人人数乘以 32%（具有合格吸烟史的估计比例）计算。我们提供了 95% 的比率置信区间 (CI)。结果：筛选的退伍军人平均年龄为 66.1 岁（标准差 [SD] = 5.6）； 95.5%为男性； 77.4% 白人。共有 119 300 次 LDCT 检查，其中 80 819 次（67.7%）是初次检查。在全国范围内，初始筛查从 2011 年的 0 次（95% CI = 0.00 至 0.00）增加到 2018 年每 1000 名符合条件的退伍军人 29.6 次（95% CI = 29.26 至 29.88）次扫描（P 趋势 < .001）。随着时间的推移，所有地理区域的初始放映数量都在增加，尤其是东北部和佛罗里达州的 VAMC。结论：2011 年至 2018 年 VHA LDCT 利用率有所增加。但总体利用率仍然较低。未来需要采取干预措施来提高合格退伍军人中肺癌筛查的利用率。
Background: Many Veterans are high risk for lung cancer. Low-dose computed tomography (LDCT) is an effective strategy for lung cancer early detection in a high-risk population. Our objective was to describe and compare annual and geographic utilization trends for LDCT screening in the Veteran's Health Administration (VHA). Methods: A national retrospective cohort of screened Veterans from January 1, 2011 to May 31, 2018 was used to calculate annual and regional rates of initial LDCT utilization per 1000 eligible Veterans. We identified Veterans with a first LDCT exam using common procedure terminology codes G0297 or 71250 and described as "lung cancer screening," "screening," or "LCS." The number of screen-eligible Veterans per year was calculated as unique Veterans aged 55 to 80 years seen at a Veterans Affairs medical center (VAMC) in that year, multiplied by 32% (estimated proportion with eligible smoking history). We present 95% confidence intervals (CI) for rates. Results: Screened Veterans had a mean age of 66.1 years (standard deviation [SD] = 5.6); 95.5% male; 77.4% Caucasian. There were 119 300 LDCT exams, of which 80 819 (67.7%) were initial. Nationally, initial screens increased from 0 (95% CI = 0.00 to 0.00) in 2011 to 29.6 (95% CI = 29.26 to 29.88) scans per 1000 eligible Veterans in 2018 (P-trend < .001). Initial screens increased over time within all geographic regions, most prominently in northeastern and Florida VAMCs. Conclusion: VHA LDCT utilization increased from 2011 to 2018. However, overall utilization remained low. Future interventions are needed to increase lung cancer screening utilization among eligible Veterans.