Community-Level Contextual Factors Associated with Lung Cancer: A Hot Spot Analysis

Purpose. Lung cancer is the leading cause of death globally, yet approximately 10–20% of people who develop lung cancer are non-smokers. This study aims to advance the literature on how community-level factors contribute to the development of lung cancer. If contextual risk factors for lung cancer burden can be identified, interventions can be implemented early to reduce geographic disparities of lung cancer and as a result, lung cancer among non-smokers. Methods The study sample consisted of N = 796 communities in Massachusetts, Connecticut, New Hampshire and Rhode Island. Following a series of spatial-based analyses (e.g., Moran’s I, Getis-Ord Gi*), a series of linear regression models were estimated to identify significant risk factors associated with lung cancer prevalence. All statistical analyses were conducted in STATA 18 and all mapping was conducted in ArcMap 10.8. Results. A total of N = 49 towns were identified as lung cancer hot spots at the 95th and 99th percentiles ( p  < .001). Hot spot towns reported higher 65 + lung cancer prevalence, chronic obstructive pulmonary disease (COPD), and temporally lagged chromium releases from toxic release inventory facilities. In regression modelling, property values, measured as median home value; historic releases of chromium from TRI facilities and ozone emissions, and comorbid prevalence of asthma and chronic obstructive pulmonary disease (COPD) significantly predicted increased lung cancer prevalence in our sample. Conclusion. This study found community rates of lung cancer are informed not only by the health and demographics of a community, but also by environmental exposures, demonstrating the importance of the social determinants of health.