Capacity constraints and disparities in the scale-up of lung cancer CT screening

描述（由申请人提供）：美国每年发生数千例可避免的癌症死亡，因为在发现和广泛的公共卫生和临床实践之间的过程中，基于证据的癌症筛查干预措施“迷失在翻译中”。鉴于最近有证据表明筛查的有效性和肺癌导致的死亡人数，肺癌筛查在减少癌症死亡方面具有巨大潜力，但很少有研究表明卫生系统的能力限制可能会像筛查其他癌症那样减缓这些努力。为了解决能力如何影响肺癌筛查的扩大，我们建议从2010-2011年基于人口的调查中估算重度吸烟者数量的地理差异，并从2008-2012年有关设施、CT扫描仪、卫生工作者和公共卫生计划的各种行政和调查数据中得出当地临床和公共卫生系统能力的衡量标准。叠加这些能力和筛查人群的数据图，我们特别打算：1。利用肺部筛查能力的多个维度，确定在扩大肺癌筛查计划方面面临能力限制的地区生活的全国重度吸烟者的比例。这将反映筛查能力和重度吸烟者人口的地理分布，以及两者之间的差异。2. 确定由于能力限制的地理差异，在获得肺癌筛查方面可能出现的种族、社会经济、农村/城市和教育方面的潜在差异。在获得其他癌症筛查方面的差距可能很大，在肺癌中，由于脆弱亚群体的吸烟率较高，这种差距可能会加剧。

DESCRIPTION (provided by applicant): Thousands of avoidable cancer deaths occur every year in the United States because evidence-based cancer screening interventions get "lost in translation" in the process between discovery and widespread public health and clinical practice. Lung cancer screening holds great potential to reduce cancer deaths, given the recent evidence of effectiveness of screening and the numbers of deaths attributable to lung cancer, but there has been little study of how capacity constraints in the health system might slow these efforts, as they have in screening for other cancers. To address how capacity might influence the scale-up of lung cancer screening, we propose to generate estimates of geographic variation in the number of heavy smokers from 2010-2011 population-based surveys, as well as measures of local clinical and public health system capacity derived from a diverse set of administrative and survey data from 2008-2012 on facilities, CT scanners, health workers, and public health programs. Superimposing these data maps of capacity and of the screening population, we specifically intend: 1. using multiple dimensions of lung screening capacity, to determine the proportion of the nation's heavy smokers living in areas that face capacity constraints to scaling up a program of lung cancer screening. This would reflect the geographic distribution of screening capacity and of the population of heavy smokers, as well as differences between the two. 2. To identify potential disparities in access to lung cancer screening that may emerge across racial, socioeconomic, rural/urban, and educational lines due to the geographic variation in capacity constraints. Disparities in access to screening for other cancers can be substantial, and may be intensified in lung cancer due to higher smoking rates among vulnerable subgroups.