Evaluation of Population-Level Changes Associated With the 2021 US Preventive Services Task Force Lung Cancer Screening Recommendations in Community-Based Health Care Systems.
Evaluation of Population-Level Changes Associated With the 2021 US Preventive Services Task Force Lung Cancer Screening Recommendations in Community-Based Health Care Systems.
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DOI：
10.1001/jamanetworkopen.2021.28176
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发表时间：
2021-10-01
影响因子：
13.8
通讯作者：
Vachani A
中科院分区：
文献类型：
--
作者：
Ritzwoller DP;Meza R;Carroll NM;Blum-Barnett E;Burnett-Hartman AN;Greenlee RT;Honda SA;Neslund-Dudas C;Rendle KA;Vachani A
这项队列研究考察了美国成人肺癌筛查资格标准的最新扩展。美国预防服务工作组(USPSTF)关于肺癌筛查的最新建议是否与符合筛查条件的个体特征分布的临床意义变化有关？在这项使用来自5个医疗保健系统的数据的队列研究中，USPSTF更新后的2021年建议与符合肺癌筛查资格的女性、种族和少数民族群体以及社会经济地位较低的个人的总体比例增加有关。2021年USPSTF关于肺癌筛查资格的建议预计将增加社区项目的机会，以减少肺癌高危个人获得肺癌筛查的障碍。美国预防服务工作组(USPSTF)发布了2021年更新的肺癌筛查建议，将筛查年龄从55岁降至50岁，吸烟史从30包年降至20包年。这些变化预计将扩大对妇女以及种族和少数民族群体的筛查机会。评估与2021年USPSTF扩大肺癌筛查资格相关的人口水平变化，按性别、种族和民族、社会人口因素和5个社区卫生保健系统的共病。这项队列研究分析了从2010年1月1日到2019年9月30日期间，从5个社区医疗保健系统中的任何一个接受护理的患者的数据(这些系统是优化筛查过程的基于人口的研究组织的成员，该联盟是一个合作组织，进行研究以更好地了解如何改善社区医疗保健环境中的癌症筛查过程)。有完整吸烟史并在医疗保健系统连续工作12个月或更长时间的个人被包括在内。那些从未吸烟或未知吸烟史的人被排除在外。电子健康记录-来自年龄、性别、种族和民族、社会经济地位(SES)、合并症和吸烟史。使用χ2检验评估2013年建议的新符合条件人口比例、年龄、性别、种族和民族、查尔森合并症指数、慢性阻塞性肺疾病诊断和自闭症以及肺癌诊断与2021年建议的预期病例的差异。截至2019年9月，目前或以前吸烟的50岁至80岁的 163人有341人。其中，34个 528拥有电子健康记录数据，捕获了包年和戒烟日期信息，并根据2013年的建议有资格进行肺癌筛查。2021年USPSTF的建议将筛查资格扩大到18533人，增幅为53.7%。与2013年相比，2021年新符合资格的人口包括5,833人(31.5%)，年龄在50岁至54岁之间，女性比例更高(52.0%[n = 9631])，以及更多的种族或少数民族群体。亚裔、夏威夷原住民或太平洋岛民新符合资格的个人比例相对增加了60.6%；西班牙裔为67.4%；非西班牙裔黑人为69.7%；非西班牙裔白人群体为49.0%。女性的相对增长比男性高13.8%(61.2%比47.4%)，并且那些共病负担较低和SES较低的人有更高的相对增长(例如，Charlson共病指数评分为0的68.7%；SES最低的61.1%)。2021年的建议与2013年的建议相比，估计肺癌确诊病例增加了30%。这项队列研究表明，在不同的医疗保健系统中，采用2021年USPSTF的建议将增加妇女、种族和少数族裔群体以及SES较低的个人有资格进行肺癌筛查的数量，从而有助于将肺癌高危个人获得筛查的障碍降至最低。
This cohort study examines the latest expansion of the lung cancer screening eligibility criteria for adults in the US. Is the updated US Preventive Services Task Force (USPSTF) recommendations for lung cancer screening associated with a clinically meaningful change in the distribution of the characteristics of individuals who are eligible for screening? In this cohort study using data derived from 5 health care systems, the updated 2021 USPSTF recommendations were associated with an increased overall proportion of women, racial and ethnic minority groups, and individuals with lower socioeconomic status who are eligible for lung cancer screening. The 2021 USPSTF recommendations for lung cancer screening eligibility are expected to enhance opportunities for community-based programs to reduce barriers to lung cancer screening access for individuals who are at highest risk for lung cancer. The US Preventive Services Task Force (USPSTF) released updated lung cancer screening recommendations in 2021, lowering the screening age from 55 to 50 years and smoking history from 30 to 20 pack-years. These changes are expected to expand screening access to women and racial and ethnic minority groups. To estimate the population-level changes associated with the 2021 USPSTF expansion of lung cancer screening eligibility by sex, race and ethnicity, sociodemographic factors, and comorbidities in 5 community-based health care systems. This cohort study analyzed data of patients who received care from any of 5 community-based health care systems (which are members of the Population-based Research to Optimize the Screening Process Lung Consortium, a collaboration that conducts research to better understand how to improve the cancer screening processes in community health care settings) from January 1, 2010, through September 30, 2019. Individuals who had complete smoking history and were engaged with the health care system for 12 or more continuous months were included. Those who had never smoked or who had unknown smoking history were excluded. Electronic health record–derived age, sex, race and ethnicity, socioeconomic status (SES), comorbidities, and smoking history. Differences in the proportion of the newly eligible population by age, sex, race and ethnicity, Charlson Comorbidity Index, chronic obstructive pulmonary disease diagnosis, and SES as well as lung cancer diagnoses under the 2013 recommendations vs the expected cases under the 2021 recommendations were evaluated using χ2 tests. As of September 2019, there were 341 163 individuals aged 50 to 80 years who currently or previously smoked. Among these, 34 528 had electronic health record data that captured pack-year and quit-date information and were eligible for lung cancer screening according to the 2013 USPSTF recommendations. The 2021 USPSTF recommendations expanded screening eligibility to 18 533 individuals, representing a 53.7% increase. Compared with the 2013 cohort, the newly eligible 2021 population included 5833 individuals (31.5%) aged 50 to 54 years, a larger proportion of women (52.0% [n = 9631]), and more racial or ethnic minority groups. The relative increases in the proportion of newly eligible individuals were 60.6% for Asian, Native Hawaiian, or Pacific Islander; 67.4% for Hispanic; 69.7% for non-Hispanic Black; and 49.0% for non-Hispanic White groups. The relative increase for women was 13.8% higher than for men (61.2% vs 47.4%), and those with a lower comorbidity burden and lower SES had higher relative increases (eg, 68.7% for a Charlson Comorbidity Index score of 0; 61.1% for lowest SES). The 2021 recommendations were associated with an estimated 30% increase in incident lung cancer diagnoses compared with the 2013 recommendations. This cohort study suggests that, in diverse health care systems, adopting the 2021 USPSTF recommendations will increase the number of women, racial and ethnic minority groups, and individuals with lower SES who are eligible for lung cancer screening, thus helping to minimize the barriers to screening access for individuals with high risk for lung cancer.
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影响因子：
3.8
作者：
Doria-Rose, V. Paul;White, Mary C.;Marcus, Pamela M.
通讯作者：
Marcus, Pamela M.
影响因子：
5.7
作者：
Carroll, Nikki M.;Burnett-Hartman, Andrea N.;Ritzwoller, Debra P.
通讯作者：
Ritzwoller, Debra P.
影响因子：
3.4
作者：
Boscoe, Francis P.;Liu, Bian;Lee, Furrina
通讯作者：
Lee, Furrina
影响因子：
39.2
作者：
Pinsky PF;Gierada DS;Black W;Munden R;Nath H;Aberle D;Kazerooni E
通讯作者：
Kazerooni E
影响因子：
3.7
作者：
Fiscella, Kevin;Winters, Paul;Mohile, Supriya G.
通讯作者：
Mohile, Supriya G.