Racial Disparities in Lung Cancer Screening Among Veterans, 2013 to 2021.
Racial Disparities in Lung Cancer Screening Among Veterans, 2013 to 2021.
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DOI：
10.1001/jamanetworkopen.2023.18795
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发表时间：
2023-06-01
影响因子：
13.8
通讯作者：
Shofer, Scott
中科院分区：
文献类型：
--
作者：
Navuluri, Neelima;Morrison, Samantha;Green, Cynthia L.;Woolson, Sandra L.;Riley, Isaretta L.;Cox, Christopher E.;Zullig, Leah L.;Shofer, Scott
在调整了各种人口统计学和社会经济学风险因素后，退伍军人中初次肺癌筛查率是否存在种族差异？在这项横断面研究中，4562名退伍军人有资格在达勒姆退伍军人事务部医疗保健系统进行肺癌筛查，黑人退伍军人完成肺癌筛查的几率显着降低，即使在调整了各种人口统计学和社会经济风险因素后。这些研究结果表明，黑人退伍军人的肺癌筛查率较低，人口和社会经济变量不能完全解释这一点，强调需要进一步对肺癌筛查障碍进行定性研究，并针对黑人退伍军人进行循证干预。这项对退伍军人进行肺癌筛查的横断面研究探讨了达勒姆退伍军人事务部医疗保健系统中是否存在筛查中的种族差异。肺癌筛查（LCS）中的种族差异通常归因于成本，保险状况，获得护理和交通等障碍。由于这些障碍在退伍军人事务系统内被最小化，因此在北卡罗来纳州的退伍军人事务医疗保健系统内是否存在类似的种族差异是一个问题。研究是否种族差异完成LCS转诊后存在于达勒姆退伍军人事务部卫生保健系统（DVAHCS），如果是这样，什么因素与筛选完成。这项横断面研究评估了2013年7月1日至2021年8月31日期间在DVAHCS提到LCS的退伍军人。所有人都包括自认为是白色或黑色的退伍军人，并在2021年1月1日达到美国预防服务工作队的资格标准。在咨询前15个月内死亡或在咨询前接受筛查的参与者被排除在外。自我报告的种族。筛选完成定义为完成LCS的计算机断层扫描。使用逻辑回归模型评估筛查完成、种族、人口统计学和社会经济学风险因素之间的关联。共有4562名退伍军人（平均[SD]年龄，65.4 [5.7]岁; 4296名[94.2%]男性; 1766名[38.7%]黑人和2796名[61.3%]白色）接受LCS。所有退伍军人转介，1692（37.1%）最终完成筛选; 2707（59.3%）从未与LCS程序后，转介和信息邮件或电话，表明在LCS过程中的一个关键点。与白色退伍军人相比，黑人退伍军人的筛查率显著较低（538 [30.5%] vs 1154 [41.3%]），在调整人口统计学和社会经济因素后，黑人退伍军人完成筛查的几率低0.66倍（95%CI，0.54-0.80）。这项横断面研究发现，在通过集中计划进行初始LCS转诊后，黑人退伍军人与白色退伍军人相比，LCS筛查完成的几率低34%，即使在考虑了众多人口和社会经济因素后，这种差异仍然存在。筛查过程中的一个关键点是退伍军人在转诊后必须与筛查计划联系。这些研究结果可用于设计，实施和评估干预措施，以提高黑人退伍军人的LCS率。
Are there racial disparities in initial lung cancer screening rates among veterans referred for screening after adjusting for various demographic and socioeconomic risk factors? In this cross-sectional study of 4562 veterans eligible for and referred for lung cancer screening at the Durham Veterans Affairs Health Care System, Black veterans had significantly lower odds of completing lung cancer screening even after adjusting for various demographic and socioeconomic risk factors. These findings suggest that Black veterans have lower rates of lung cancer screening that are not fully explained by demographic and socioeconomic variables, underscoring the need for further qualitative studies on barriers to lung cancer screening as well as evidence-based interventions targeted to Black veterans. This cross-sectional study of veterans referred for lung cancer screening examines whether racial disparities in screening exist within the Durham Veterans Affairs Health Care System. Racial disparities in lung cancer screening (LCS) are often ascribed to barriers such as cost, insurance status, access to care, and transportation. Because these barriers are minimized within the Veterans Affairs system, there is a question of whether similar racial disparities exist within a Veterans Affairs health care system in North Carolina. To examine whether racial disparities in completing LCS after referral exist at the Durham Veterans Affairs Health Care System (DVAHCS) and, if so, what factors are associated with screening completion. This cross-sectional study assessed veterans referred to LCS between July 1, 2013, and August 31, 2021, at the DVAHCS. All included veterans self-identified as White or Black and met the US Preventive Services Task Force eligibility criteria as of January 1, 2021. Participants who died within 15 months of consultation or who were screened before consultation were excluded. Self-reported race. Screening completion was defined as completing computed tomography for LCS. The associations among screening completion, race, and demographic and socioeconomic risk factors were assessed using logistic regression models. A total of 4562 veterans (mean [SD] age, 65.4 [5.7] years; 4296 [94.2%] male; 1766 [38.7%] Black and 2796 [61.3%] White) were referred for LCS. Of all veterans referred, 1692 (37.1%) ultimately completed screening; 2707 (59.3%) never connected with the LCS program after referral and an informational mailer or telephone call, indicating a critical point in the LCS process. Screening rates were substantially lower among Black compared with White veterans (538 [30.5%] vs 1154 [41.3%]), with Black veterans having 0.66 times lower odds (95% CI, 0.54-0.80) of screening completion after adjusting for demographic and socioeconomic factors. This cross-sectional study found that after referral for initial LCS via a centralized program, Black veterans had 34% lower odds of LCS screening completion compared with White veterans, a disparity that persisted even after accounting for numerous demographic and socioeconomic factors. A critical point in the screening process was when veterans must connect with the screening program after referral. These findings may be used to design, implement, and evaluate interventions to improve LCS rates among Black veterans.
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