Identifying priority populations for lung cancer screening intervention using neighborhood-level factors and cancer registry data

Abstract

Objective To evaluate association of neighborhood-level economic, environmental, and social indicators with lung cancer (LC) incidence and mortality. Data for adult incident LC cases in Allegheny County, Pennsylvania, diagnosed between 2015–2019 were obtained from the Pennsylvania Cancer Registry. Cases were summarized and linked to neighborhood deprivation index (NDI), built environment, and racial isolation at census-tracts level. Poisson regression model computed relative risk (RR) for LC incidence and mortality, adjusting for covariates. A total of 3256 LC cases were included in the analyses with 68% ≥65 years, 54% female, 14% Black or African American, and 63% deceased. Results found that increasing quintiles (Q) of NDI were significantly associated with increasing risk of LC incidence and mortality. The RRs (95% confidence interval) of LC incidence for Q2, Q3, Q4, and Q5 were 1.36 (1.21–1.52), 1.55 (1.40–1.72), 1.68 (1.51–1.87), and 2.08 (1.82–2.38), respectively, compared with Q1 (P trend <0.01). The corresponding RRs for LC mortality were 1.46 (1.27–1.68), 1.63 (1.42–1.88), 1.74 (1.51–2.01), and 2.04 (2.02–2.88) (P trend <0.01). Targeted interventions for LC prevention and early detection in high NDI neighborhoods may be more effective to reduce LC health disparities.

Keywords

• Lung cancer
• social determinants of health
• environmental health
• neighborhood deprivation index
• cancer registry