Opportunistic Screening for Cardiovascular and Chronic Obstructive Pulmonary Disease Biomarkers and Implications for Downstream Care: A Retrospective Lung Cancer Screening Cohort Study.

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.