Background

To address disparities in lung cancer screening (LCS) that may exclude large numbers of high-risk African American smokers, revised U.S. Preventive Services Task Force (USPSTF) recommendations lowered LCS eligibility thresholds. However, there are limited recent data about the impact of newly revised guidelines on disparities in LCS eligibility.

Purpose

To evaluate the impact of revised USPSTF guidelines on racial and ethnic disparities in LCS eligibility.

Materials and Methods

Cross-sectional survey data from 20 states were retrospectively evaluated from the 2019 Behavioral Risk Factor Surveillance System survey (median response rate, 49.4%). Respondents without a history of lung cancer aged 55–79 years (ie, under the previous guidelines) or aged 50–79 years (ie, under the revised guidelines) were included. Multivariable logistic regression analyses were performed to evaluate the association between race and ethnicity and LCS eligibility. All analyses were performed accounting for complex survey design features (ie, weighting, stratification, and clustering).

Results

Under previous guidelines, 11% of 67 567 weighted survey respondents were eligible for LCS (White [12%], Hispanic [4%], African American [7%], American Indian [17%], Asian or Pacific Islander [4%], and other [12%]). Under revised USPSTF guidelines, 14% of 77 689 weighted survey respondents were eligible for LCS (White [15%], Hispanic [5%], African American [9%], American Indian [21%), Asian or Pacific Islander [5%], and other [18%]). Compared with White respondents, African American respondents (adjusted odds ratio [OR] = 0.36; 95% CI: 0.27, 0.47; P < .001) and Hispanic respondents (adjusted OR = 0.15; 95% CI: 0.09, 0.24; P < .001) were less likely to be eligible for LCS under previous guidelines. African American respondents (adjusted OR = 0.39; 95% CI: 0.32, 0.47; P < .001) and Hispanic respondents (adjusted OR = 0.15; 95% CI: 0.10, 0.23; P < .001) were less likely to be eligible under the revised guidelines. The Wald test showed no evidence of differences in the degree to which racial and ethnic minority groups were less likely to be eligible for LCS when comparing previous versus revised USPSTF guidelines (P = .76).

Conclusion

The revised U.S. Preventive Services Task Force guidelines (version 2.0) may perpetuate lung cancer disparities, as racial and ethnic minority groups are still less likely to be eligible for lung cancer screening.

© RSNA, 2021

Online supplemental material is available for this article.

See also the editorial by Jacobs and Springfield in this issue.

中文翻译：

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肺癌筛查资格的种族和民族差异

背景

为了解决肺癌筛查 (LCS) 中可能排除大量高危非裔美国吸烟者的差异，修订后的美国预防服务工作组 (USPSTF) 建议降低了 LCS 资格门槛。然而，关于新修订的指南对 LCS 资格差异的影响的最新数据有限。

目的

评估修订后的 USPSTF 指南对 LCS 资格中种族和民族差异的影响。

材料和方法

来自 20 个州的横断面调查数据是从 2019 年行为风险因素监测系统调查中回顾性评估的（中位响应率，49.4%）。年龄在 55-79 岁（即，根据之前的指南）或 50-79 岁（即，根据修订后的指南）没有肺癌病史的受访者被纳入。进行多变量逻辑回归分析以评估种族和民族与 LCS 资格之间的关联。所有分析都考虑了复杂的调查设计特征（即加权、分层和聚类）。

结果

根据之前的指南，67 567 名加权调查受访者中有 11% 有资格获得 LCS（白人 [12%]、西班牙裔 [4%]、非裔美国人 [7%]、美洲印第安人 [17%]、亚洲或太平洋岛民 [4%] ] 和其他 [12%]）。根据修订后的 USPSTF 指南，77689 名加权调查受访者中有 14% 有资格获得 LCS（白人 [15%]、西班牙裔 [5%]、非裔美国人 [9%]、美洲印第安人 [21%）、亚洲或太平洋岛民 [5] %] 和其他 [18%]）。与白人受访者相比，非裔美国人受访者（调整后的优势比 [OR] = 0.36；95% CI：0.27、0.47；P < .001）和西班牙裔受访者（调整后 OR = 0.15；95% CI：0.09、0.24；P < .001) 根据之前的指南，不太可能符合 LCS 的条件。非裔美国人受访者（调整后 OR = 0.39；95% CI：0.32、0.47；P< .001）和西班牙裔受访者（调整后的 OR = 0.15；95% CI：0.10, 0.23；P < .001）不太可能符合修订后的指南。Wald 检验表明，在比较之前与修订后的 USPSTF 指南时，种族和少数族裔群体不太可能符合 LCS 的资格，没有证据表明存在差异（P = .76）。

结论

修订后的美国预防服务工作组指南（2.0 版）可能会延续肺癌的差异，因为种族和少数族裔群体仍然不太可能符合肺癌筛查的条件。

©北美放射学会，2021

本文提供了在线补充材料。

另请参阅本期 Jacobs 和 Springfield 的社论。