Differences in lung cancer screening outcomes and follow-up by patient, provider and place-based characteristics in Missouri and Illinois: A cross-sectional study

Background Lung cancer remains the leading cause of cancer-related mortality in the United States, yet disparities in lung cancer screening (LCS) outcomes exist and remain understudied, particularly in the Midwestern region. Our objective was to investigate disparities in lung radiology outcomes and follow-up care based on patient, provider, and place-based characteristics (i.e., area deprivation index; ADI). Methods This cross-sectional study used data from the LCS program at Siteman Cancer Center (SCC) in St. Louis, Missouri, from January to December 2023. SCC’s catchment area includes 82 counties in Missouri and Illinois; approximately 15% of the population reside in a rural zip code, and 29% reside in medically underserved areas 80% are White. The study included 1,946 individuals aged 50–80, meeting LCS eligibility criteria based on smoking history and age. Lung radiology findings were assessed as primary outcomes, and timely follow-up adherence (i.e., return for follow-up visit) was analyzed among patients with high-risk findings (Lung-RADS 3 [”Probably Benign”] and 4 [”Suspicious”]) from January to June 2023, requiring follow-up by December 2023. Multivariable logistic regression was conducted, adjusting for patient and provider characteristics and ADI. Results Of the 1,946 individuals who accessed LCS, 57% were Black, 41% White, 1% Asian, and 1% of another race; 54% were male and 46% female. Lung findings were classified as "probably benign/suspicious" (high risk) for 14%. Annual visits were associated with higher likelihood of high-risk scores compared to baseline visits (AOR = 2.10 (1.40–3.15); p < 0.001). Racial differences were noted in the association between provider type and lung outcomes. Among White individuals only, specialist compared to primary care provider referral was associated with increased odds of being high risk (AOR = 1.58 (1.00–2.50); p = 0.048). Sex, insurance, smoking status, park-years and ADI were not associated with lung radiology outcomes. Timely adherence to return follow-up visit among high-risk patients was suboptimal, with only 20.0% returning within 3–6 months for their repeat LCS. Individuals residing in moderate ADI (distress) areas were less likely to have timely follow-up (for high-risk findings) compared to those in high distress (AOR = 0.393, 95% CI = 0.155–1.001, p = 0.050). There were no differences by sex, insurance, smoking status, and pack-years for being classified as high risk. Conclusions SCC’s LCS program successfully captured Black populations and individuals from highly distressed areas, in a predominantly White catchment area. There were no observable race disparities in timely follow-up of high-risk findings, reflecting progress toward equity in access and outcomes. Place-based disparities in follow-up were observed that warrant further characterization and risk assessment to improve follow-up of patients undergoing LCS.