The Landscape of US Lung Cancer Screening Services
The Landscape of US Lung Cancer Screening Services
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DOI：
10.1016/j.chest.2018.10.039
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发表时间：
2019-05-01
期刊：
影响因子：
9.6
通讯作者：
Liu, Bian
中科院分区：
文献类型：
--
作者：
Kale, Minal S.;Wisnivesky, Juan;Liu, Bian
背景技术背景：肺癌筛查的低采用率可能是由于无法充分获得全面的肺癌筛查登记处（LCSR），目前这是医疗保险和医疗补助服务中心的报销要求。然而，LCSR设施的变化尚未得到广泛的研究。方法：我们将分层聚类方法应用于一个综合数据库，该数据库整合了国家级LCSR设施密度，定义为每10万高危人群的设施数量，肺癌结局，包括死亡率和阶段特异性发病率，以及社会经济和行为因素。我们发现三个不同的集群LCSR设施大致对应的北方（集群1），东南（集群2），西南（集群3）的国家。东南部各州的设施总数最少（第2组67 +/- 44，第1组74 +/- 69，第3组80 +/- 100），设施增加最慢（第2组23 +/- 20，第1组26 +/- 28，第3组27 +/- 32），以及最高的肺癌负担和当前吸烟者。他们在设施密度方面排名第二（第3组2.9 +/- 1.0，第2组3.8 +/- 1.3，第1组6.3 +/- 2.8）和设施密度增加结论：我们发现LCSR设施与肺癌负担、社会经济特征和行为特征相关的州一级变异性很大。鉴于已知的肺癌风险因素，纠正筛查计划的次优分布可能会改善肺癌的预后。
BACKGROUND: Low adoption of lung cancer screening is potentially caused by inadequate access to a comprehensive lung cancer screening registry (LCSR), currently a requirement for reimbursement by the Centers for Medicare and Medicaid Services. However, variations in LCSR facilities have not been extensively studied.METHODS: We applied a hierarchical clustering method to a comprehensive database integrating state-level LCSR facility density, defined as the number of facilities per 100,000 at-risk persons, lung cancer outcomes including mortality and stage-specific incidence, and socioeconomic and behavioral factors.RESULTS: We found three distinct clusters of LCSR facilities roughly corresponding to the northern (cluster 1), southeastern (cluster 2), and southwestern (cluster 3) states. The southeastern states had the lowest total number of facilities (67 +/- 44 in cluster 2, 74 +/- 69 in cluster 1, 80 +/- 100 in cluster 3), the slowest increase in facilities (23 +/- 20 in cluster 2, 26 +/- 28 in cluster 1, 27 +/- 32 in cluster 3) between 2016 and 2018, and the highest lung cancer burden and current smokers. They ranked second in terms of facility density (2.9 +/- 1.0 in cluster 3, 3.8 +/- 1.3 in cluster 2, 6.3 +/- 2.8 in cluster 1) and increase in facility density (1.1 +/- 0.3 in cluster 3, 1.3 +/- 0.7 in cluster 2, 2.5 +/- 2.5 in cluster 1).CONCLUSIONS: We found substantial state-level variability in LCSR facilities tied to lung cancer burden, socioeconomic characteristics, and behavioral characteristics. Given the known risk factors of lung cancer, correcting a suboptimal distribution of screening programs will likely lead to improved lung cancer outcomes.