Census Tract Rurality, Predominant Race and Ethnicity, and Distance to Lung Cancer Screening Facilities : An Ecological Study.
Publication Title
Annals of internal medicine
Document Type
Article
Publication Date
2-1-2025
Keywords
Humans; Lung Neoplasms; Cross-Sectional Studies; Male; Female; Health Services Accessibility; Middle Aged; Rural Population; Early Detection of Cancer; United States; Aged; Censuses; Ethnicity; Racial Groups; White People; White; washington; swedish; swedish thoracic surgery; diversity
Abstract
BACKGROUND: The U.S. Preventive Services Task Force recommends annual lung cancer screening (LCS) for adults who meet specific age and smoking history criteria.
OBJECTIVE: To evaluate race-, ethnicity-, and rurality-based differences in distance to the nearest LCS facility.
DESIGN: Cross-sectional ecological study.
SETTING: U.S. census tracts.
PARTICIPANTS: 71 691 census tracts.
MEASUREMENTS: The outcome variable was road network distance in miles between a census tract and the nearest LCS facility. Distance was log-transformed, and geometric means are reported. Census tracts were classified as majority (>50%) American Indian/Alaska Native (AI/AN), Asian, Black, non-Hispanic White (NHW), no single race, or Hispanic. Rurality was defined using the rural-urban commuting area codes. Ordinary least-squares regression examined the associations between distance and census tract race, ethnicity, and rurality.
RESULTS: Geometric mean distance to the nearest LCS facility was 6.5 miles. Compared with NHW-majority census tracts, distance to the nearest LCS facility was 5.26 times (426%) longer in AI/AN-majority census tracts and 7% to 39% shorter in Asian-, Black-, and Hispanic-majority census tracts. Adjustment for rurality reduced the mean distance in AI/AN-majority census tracts, but the mean distance was still 3.16 times the distance in NHW-majority census tracts. Adjustment for rurality reduced the observed advantage in Asian- and Black-majority census tracts and changed the direction of associations in Hispanic-majority census tracts.
LIMITATION: Analyses did not account for travel time or cost.
CONCLUSION: Differences exist in distance to LCS facilities by race and ethnicity that can only be partially explained by rurality.
PRIMARY FUNDING SOURCE: Lung Ambition Alliance and the Center for Lung Research in Honor of Wayne Gittinger.
Area of Special Interest
Cancer
Specialty/Research Institute
Oncology
Specialty/Research Institute
Pulmonary Medicine
Specialty/Research Institute
Internal Medicine
DOI
10.7326/M24-0124
