Lung Cancer Screening Eligibility and Use in the US: A Cross-Sectional Analysis of 2022 Behavioral Risk Factor Surveillance System Data

OBJECTIVES: This study’s purpose is to assess sociodemographic and health-related variations in lung cancer screening (LCS) use among eligible individuals in the U.S. in 2022.

METHODS: We analyzed data from the 2022 Behavioral Risk Factor Surveillance System. We included adults 50 to 79 years old who reported smoking currently or quit within 15 years, and a 20-plus pack-year smoking history; these criteria reflect the 2021 United States Preventive Services Task Force recommendation on LCS. Covariates include age, race and ethnicity, educational attainment, household income, health insurance coverage, delays in medical care due to cost, and general health.

RESULTS: The final weighted sample consisted of 12,826,424 respondents (mean [SD] age = 65.7 [6.9] years), most of whom were non-Hispanic White (78.9%). Overall, LCS was reported by 16.4% (95%CI: 15.5-17.3) of the eligible respondents.

The logistic regression results show a lower likelihood of receiving LCS among the following groups: multiracial compared to non-Hispanic White participants (OR=0.49, 95%CI: 0.33-0.73); participants who did not have health insurance compared to those with private insurance (OR=0.41, 95%CI: 0.25-0.69); respondents who delayed medical care in the past year due to cost compared to those who did not (OR=0.53, 95%CI: 0.42-0.68); and individuals with fair (OR=0.81, 95%CI: 0.65-1.01), good (OR=0.74, 95%CI: 0.59-0.93), very good (OR=0.56, 95%CI: 0.44-0.72), and excellent (OR=0.51, 95%CI: 0-37-0.72) compared to those with poor health. Conversely, those with public insurance (OR=1.28, 95%CI: 1.06-1.54) had a higher likelihood of receiving LCS than respondents with private insurance; this is likely due to Medicare coverage among older adults.

CONCLUSIONS: About 1 in every 6 adults eligible for LCS were screened in 2022. Our analysis shows persistent disparities in LCS completion among individuals with barriers to care. High use among individuals with poorer health, a group where LCS may not be beneficial, is an area for further analysis.