Evaluation of Revised US Preventive Services Task Force Lung Cancer Screening Guideline Among Women and Racial/Ethnic Minority Populations.
Evaluation of Revised US Preventive Services Task Force Lung Cancer Screening Guideline Among Women and Racial/Ethnic Minority Populations.
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DOI：
10.1001/jamanetworkopen.2020.33769
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发表时间：
2021-01-04
影响因子：
13.8
通讯作者：
Wetter DW
中科院分区：
文献类型：
--
作者：
Reese TJ;Schlechter CR;Potter LN;Kawamoto K;Del Fiol G;Lam CY;Wetter DW
修订后的美国预防服务工作组（USPSTF）肺癌筛查指南在女性、黑人和西班牙裔人群中的筛查资格将发生哪些变化？在这项2017年和2018年行为风险因素监测系统的横断面研究中，目前和以前吸烟者中有资格接受筛查的比例增加了30.3%，男性增加了40.5%，女性增加了40.5%，白色增加了31.9%，黑人增加了76.7%，西班牙裔增加了78.1%。与男性相比，女性的合格几率较低，与白色相比，黑人和西班牙裔个体的合格几率较低。这些结果表明，在修订后的指南中，女性和种族/少数民族人群的筛查差异可能会持续存在。这项横断面研究评估了修订后的美国预防服务工作组指南与女性，黑人和西班牙裔人群中肺癌筛查资格相关的变化，使用了一项大型全国性调查。肺癌的发病率和死亡率不成比例地影响女性和种族/少数民族人群，但过去几年的筛查指南主要来自白色男性的临床试验。为了反映当前的证据，美国预防服务工作组（USPSTF）修订了合格标准，这可能有助于改善肺癌筛查中与性别和种族/民族相关的差异。通过一项大型全国性调查，确定修订后的USPSTF指南在女性、黑人和西班牙裔人群中肺癌筛查资格的相关变化。这项横断面研究包括疾病控制和预防中心行为风险因素监测系统的受访者，他们年龄在50至80岁之间，在19个使用可选肺癌筛查模块的州有吸烟史。研究了女性、男性、黑人、西班牙裔和白色参与者的资格变化。按性别和人种/种族将合格性与参考人群进行比较。数据收集时间为2017年1月1日至2018年12月31日，分析时间为2020年5月8日至6月11日。自我报告的性别、种族/民族、年龄和吸烟史。使用修订的USPSTF标准进行肺癌筛查的资格。以前的标准包括目前或过去的吸烟者（15年内），年龄在55至80岁之间，吸烟史超过30包年。在修订后的标准中，年龄修改为50至80岁;吸烟史修改为20包年。在40869名年龄在50 - 80岁之间有吸烟史的受访者中，21265名（52.0%）为女性，3430名（8.4%）为黑人，1226名（30.0%）为西班牙裔（平均[SD]年龄，65.6 [7.9]岁）。修订后的标准增加了以下人群的资格：（29.4%至38.3% [8.9%差异]; P < .001），女性（25.9%至36.4% [10.5%差异]; P < .001），白色个体（31.1%至40.9% [9.8%差异]; P < .001），黑人个体（16.3%至28.8% [12.5%差异]; P < .001）和西班牙裔个体（10.5%至18.7% [8.2%差异]; P < .001）。与男性相比，女性获得资格的几率较低（调整后的比值比[AOR]，0.88; 95% CI，0.79-0.99; P = 0.04）和黑人（AOR，0.43; 95% CI，0.33-0.56; P < .001）和西班牙裔人群（AOR，0.70; 95% CI，0.62-0.80; P < .001）与白色人群相比。修订后的USPSTF指南可能会增加女性，黑人和西班牙裔人群的肺癌筛查率。然而，尽管有这些潜在的改善，肺癌筛查的不公平性可能会持续没有定制的资格标准。
What change will be associated with the revised US Preventive Services Task Force (USPSTF) lung cancer screening guideline for screening eligibility among female, Black, and Hispanic populations? In this cross-sectional study of the Behavioral Risk Factor Surveillance System for 2017 and 2018, the proportion eligible for screening among current and former smokers increased by 30.3% for men, 40.5% for women, and 31.9% for White, 76.7% for Black, and 78.1% for Hispanic populations. Compared with men, women had lower odds of eligibility, and compared with White, Black and Hispanic individuals had lower odds of eligibility. These findings suggest that screening disparities may persist among women and racial/ethnic minority populations with the revised guideline. This cross-sectional study assesses the changes associated with the revised US Preventive Services Task Force guideline with lung cancer screening eligibility among female, Black, and Hispanic populations using a large nationwide survey. Lung cancer incidence and mortality disproportionately affect women and racial/ethnic minority populations, yet screening guidelines for the past several years were derived from clinical trials of predominantly White men. To reflect current evidence, the US Preventive Services Task Force (USPSTF) has revised the eligibility criteria, which may help to ameliorate sex- and race/ethnicity–related disparities in lung cancer screening. To determine the changes associated with the revised USPSTF guideline for lung cancer screening eligibility among female, Black, and Hispanic populations using a large nationwide survey. This cross-sectional study included respondents to the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System who were 50 to 80 years of age with a smoking history in 19 states that used the optional lung cancer screening module. The change in eligibility among female, male, Black, Hispanic, and White participants was examined. Eligibility by sex and race/ethnicity was compared with a reference population. Data were collected from January 1, 2017, to December 31, 2018, and analyzed from May 8 to June 11, 2020. Self-reported sex, race/ethnicity, age, and smoking history. Lung cancer screening eligibility using the revised USPSTF criteria. The previous criteria included current or past smokers (within 15 years) who were 55 to 80 years of age and had a smoking history of more than 30 pack-years. In the revised criteria, age was modified to 50 to 80 years; smoking history, to 20 pack-years. Among 40 869 respondents aged 50 to 80 years with a smoking history, 21 265 (52.0%) were women, 3430 (8.4%) were Black, and 1226 (30.0%) were Hispanic (mean [SD] age, 65.6 [7.9] years). The revised criteria increased eligibility for the following populations: men (29.4% to 38.3% [8.9% difference]; P < .001), women (25.9% to 36.4% [10.5% difference]; P < .001), White individuals (31.1% to 40.9% [9.8% difference]; P < .001), Black individuals (16.3% to 28.8% [12.5% difference]; P < .001), and Hispanic individuals (10.5% to 18.7% [8.2% difference]; P < .001). The odds of eligibility were lower for women compared with men (adjusted odds ratio [AOR], 0.88; 95% CI, 0.79-0.99; P = .04) and for Black (AOR, 0.43; 95% CI, 0.33-0.56; P < .001) and Hispanic populations (AOR, 0.70; 95% CI, 0.62-0.80; P < .001) compared with the White population. The revised USPSTF guideline may likely increase lung cancer screening rates for female, Black, and Hispanic populations. However, despite these potential improvements, lung cancer screening inequities may persist without tailored eligibility criteria.
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DOI：
10.1097/00001648-199001000-00010
发表时间：
1990-01-01
期刊：
Epidemiology (Cambridge, Mass.)
影响因子：
--
作者：
Rothman, K J
通讯作者：
Rothman, K J
影响因子：
4.5
作者：
RAO, JNK;SCOTT, AJ
通讯作者：
SCOTT, AJ
影响因子：
39.2
作者：
Moyer, Virginia A.
通讯作者：
Moyer, Virginia A.
影响因子：
12.7
作者：
PEREZSTABLE, EJ;MARIN, BV;BENOWITZ, NL
通讯作者：
BENOWITZ, NL
影响因子：
2.3
作者：
Li, Chien-Ching;Matthews, Alicia K.;Shah, Raj C.
通讯作者：
Shah, Raj C.