Racial Differences in Adherence to Lung Cancer Screening Follow-up A Systematic Review and Meta-analysis
Racial Differences in Adherence to Lung Cancer Screening Follow-up A Systematic Review and Meta-analysis
复制标题
DOI：
10.1016/j.chest.2021.07.2172
复制
发表时间：
2022-01-06
期刊：
影响因子：
9.6
通讯作者：
Bastian, Lori A.
中科院分区：
文献类型：
--
作者：
Kunitomo, Yukiko;Bade, Brett;Bastian, Lori A.
背景：2013年，美国预防服务工作组建议对高危个人进行年度肺癌筛查(LCS)，并使用低剂量胸部CT成像。LCS降低了肺癌死亡率，在临床试验中观察到黑人参与者的降幅更大。尽管肺癌死亡率的种族差异已经有了很好的记录，但在临床实践中，关于LCS参与和坚持随访的差异却知之甚少。研究问题：种族与坚持LCS随访之间的关联是什么？研究设计方法：通过搜索MEDLINE、PubMed、EMBASE、Web of Science、Cumulative Index to Nursing和联合健康文献数据库从数据库建立到2020年10月的已发表研究进行系统综述。我们纳入了检查LCS随访率的研究，并比较了不同种族的依从率。结果：我们筛选了18,300篇标题和摘要，其中229篇研究被选作全文综述。9项研究符合纳入标准；7项纳入荟萃分析。中位随访率为37%(16%~82%)。这些研究之间的显著差异包括黑人人口的比例(范围为4%-47%)和LCS项目的结构。Meta分析显示，黑人人群对LCS随访的依从性较低(OR，0.67；95%CI，0.55-0.80)。这一差异在所有由初步筛查结果确定的恶性肿瘤风险水平上持续存在。干预：与白人患者相比，黑人患者对LCS随访的依从性较低，尽管潜在的肺癌死亡率好处更高。专门涉及遵守LCS的种族相关障碍的文献仍然有限。为了确保LCS福利的公平，应该通过增加医生教育和使用筛查计划协调员来重点关注这一患者群体，对符合条件的黑人患者进行更多的外联。
BACKGROUND: In 2013, the United States Preventive Services Taskforce instituted recommendations for annual lung cancer screening (LCS) with low-dose chest CT imaging for high-risk individuals. LCS reduces lung cancer mortality, with greater reduction observed in Black participants in clinical trials. Although racial disparities in lung cancer mortality have been well documented, less is known about disparities in LCS participation and adherence to follow-up in clinical practice.RESEARCH QUESTIONS: What is the association between race and adherence to LCS follow-up?STUDY DESIGN METHODS: A systematic review was conducted through a search of published studies in MEDLINE, PubMed, EMBASE, Web of Science, and Cumulative Index to Nursing and Allied Health Literature Database from database inception through October 2020. We included studies that examined rates of adherence to LCS follow-up and compared rates by race. Studies were pooled using random-effects meta-analysis.RESULTS: We screened 18,300 titles and abstracts, and 229 studies were selected for full-text review. Nine studies met inclusion criteria; seven were included in the meta-analysis. Median adherent follow-up rate was 37% (range, 16%-82%). Notable differences among the studies included the proportion of the Black population (range, 4%-47%) and the structure of the LCS programs. The meta-analyses showed lower adherence to LCS follow-up in the Black population (OR, 0.67; 95% CI, 0.55-0.80). This disparity persisted across all malignancy risk levels determined by initial screening results.INTERPRETATION: Lower adherence to LCS follow-up in Black compared with White patients occurs despite the higher potential lung cancer mortality benefit. Literature specifically addressing race-related barriers to LCS adherence remains limited. To ensure equity in LCS benefits, greater outreach to eligible Black patients should be implemented through increased physician education and use of screening program coordinators to focus on this patient population.