Lung Cancer Screening Among U.S. Military Veterans by Health Status and Race and Ethnicity, 2017–2020: A Cross-Sectional Population-Based Study
Alison S. Rustagi, MD, PhD,
Amy L. Byers, PhD, MPH,
James K. Brown, MD,
Natalie Purcell, PhD,
Christopher G. Slatore, MD, MS,
Salomeh Keyhani, MD, MPH
Affiliations
Alison S. Rustagi, MD, PhD
Division of General Internal Medicine, Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, California; Department of Medicine, University of California, San Francisco, California; Address correspondence to: Alison S. Rustagi, MD, PhD, Division of General Internal Medicine, Medical Service, San Francisco Veterans Affairs Health Care System, 4150 Clement Street, Mail Code 111A1 T-31, Building 18, Room 118, San Francisco CA 94122.
Amy L. Byers, PhD, MPH
Department of Medicine, University of California, San Francisco, California; Research Service, San Francisco Veterans Affairs Health Care System, San Francisco, California; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California; Weill Institute for Neurosciences, University of California, San Francisco, California
James K. Brown, MD
Department of Medicine, University of California, San Francisco, California; Division of Pulmonary, Critical Care, and Sleep Medicine, Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, California;
Natalie Purcell, PhD
Integrative Health, San Francisco Veterans Affairs Health Care System, San Francisco, California;; Social Behavioral Health Sciences, School of Nursing, University of California, San Francisco, California
Christopher G. Slatore, MD, MS
National Center for Lung Cancer Screening, Veterans Health Administration, Washington, District of Columbia; Division of Pulmonary and Critical Care Medicine, VA Portland Health Care System, Portland, Oregon; Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon
Salomeh Keyhani, MD, MPH
Division of General Internal Medicine, Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, California; Department of Medicine, University of California, San Francisco, California
Introduction: Veterans are at high risk for lung cancer and are an important group for lung cancer screening. Previous research suggests that lung cancer screening may not be reaching healthier and/or non-White individuals, who stand to benefit most from lung cancer screening. We sought to test whether lung cancer screening is associated with poor health and/or race and ethnicity among veterans. Methods: This cross-sectional, population-based study included veterans eligible for lung cancer screening (aged 55–79 years, ≥30 pack-year smoking history, current smokers or quit within 15 years, no previous lung cancer) in the 2017–2020 Behavioral Risk Factor Surveillance System surveys. Exposures were (1) poor health, defined as fair/poor health status and difficulty walking or climbing stairs, aligning with eligibility criteria for a pivotal lung cancer screening trial, and (2) race/ethnicity. The outcome was a receipt of lung cancer screening. All variables were self-reported. Results: Of 3,376 lung cancer screening–eligible veterans representing an underlying population of 866,000 individuals, 20.3% (95% CI=17.3, 23.6) had poor health, and 13.7% (95% CI=10.6, 17.5) identified as non-White. Poor health was strongly associated with lung cancer screening (adjusted RR=1.64, 95% CI=1.06, 2.27); one third of veterans screened for lung cancer would not qualify for a pivotal lung cancer screening trial in terms of health. Marked racial disparities were observed among veterans: after adjustment, non-White veterans were 67% less likely to report lung cancer screening than White veterans (adjusted RR=0.33, 95% CI=0.11, 0.66). Conclusions: Lung cancer screening is correlated with poorer health and White race/ethnicity among veterans, which may undermine its population-level effectiveness. These results highlight the need to promote lung cancer screening, especially for healthier and/or non-White veterans, an important group of Americans for lung cancer screening.
