Journal of the American College of Radiology : JACR · 2026
Opportunistic Screening for Cardiovascular and Chronic Obstructive Pulmonary Disease Biomarkers and Implications for Downstream Care: A Retrospective Lung Cancer Screening Cohort Study.
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Groner Lauren K, Puello Maria Patricia, Onyebeke Chukwuma, Thomas Charlene, Corzo Valentina Marulanda, Andrade Tashina, Haile Hanna, Saleh Anthony, Pena Jessica M, Green Daniel B, Pinheiro Laura C
Аннотация
OBJECTIVE: Examine the prevalence of low-dose CT (LDCT) biomarkers for cardiovascular disease (CVD) (coronary artery calcium [CAC]) and chronic obstructive pulmonary disease (emphysema) in asymptomatic lung cancer screening (LCS) participants and its association with downstream care and social determinants of health (SDoH).
METHODS: In this retrospective NYC health-system study, LDCT reports of LCS enrollees with baseline LDCT (2015-2022) were reviewed for emphysema and CAC. Cardiopulmonary care within 12 months was compared using McNemar's chi-squared test. Newly received care was compared between participants with and without CAC and emphysema using chi-square or Fisher exact tests. Associations with demographic and area-level characteristics were assessed using logistic regression.
RESULTS: Among 2,361 participants (median age, 64; 52% male), emphysema was identified in 76.7% and CAC in 65.1%. Post-LDCT, pulmonary care increased from 24.4% to 45.8% and cardiovascular care from 42.6% to 63.3% (p<0.001). Lower ZIP-level median household income (aOR, 1.57 [95% CI, 1.22-2.02]) and greater food insecurity (1.52 [1.20-1.94]) were associated with higher odds of emphysema (both p<0.001); no SDoH was associated with CAC. Among those with emphysema, high-poverty ZIP residence (1.74 [1.25-2.42], p<0.001) was associated with higher odds of post-LDCT pulmonary care; among those with CAC, lower ZIP-level educational attainment (0.76 [0.60-0.98]; p=0.033) was associated with lower odds of post-LDCT cardiovascular care.
DISCUSSION: Emphysema and CAC are highly prevalent and associated with increased post-LDCT cardiopulmonary care; however, future studies are needed to determine whether increased utilization improves clinical outcomes. SDoH were associated with emphysema burden and patterns of post-LDCT care, underscoring the need for equitable care pathways.
METHODS: In this retrospective NYC health-system study, LDCT reports of LCS enrollees with baseline LDCT (2015-2022) were reviewed for emphysema and CAC. Cardiopulmonary care within 12 months was compared using McNemar's chi-squared test. Newly received care was compared between participants with and without CAC and emphysema using chi-square or Fisher exact tests. Associations with demographic and area-level characteristics were assessed using logistic regression.
RESULTS: Among 2,361 participants (median age, 64; 52% male), emphysema was identified in 76.7% and CAC in 65.1%. Post-LDCT, pulmonary care increased from 24.4% to 45.8% and cardiovascular care from 42.6% to 63.3% (p<0.001). Lower ZIP-level median household income (aOR, 1.57 [95% CI, 1.22-2.02]) and greater food insecurity (1.52 [1.20-1.94]) were associated with higher odds of emphysema (both p<0.001); no SDoH was associated with CAC. Among those with emphysema, high-poverty ZIP residence (1.74 [1.25-2.42], p<0.001) was associated with higher odds of post-LDCT pulmonary care; among those with CAC, lower ZIP-level educational attainment (0.76 [0.60-0.98]; p=0.033) was associated with lower odds of post-LDCT cardiovascular care.
DISCUSSION: Emphysema and CAC are highly prevalent and associated with increased post-LDCT cardiopulmonary care; however, future studies are needed to determine whether increased utilization improves clinical outcomes. SDoH were associated with emphysema burden and patterns of post-LDCT care, underscoring the need for equitable care pathways.