Socioeconomic and smoking-related disparities in lung Cancer prevalence among U.S.Adults: a pooled analysis of the behavioral risk factor surveillance system, 2022-2024.

OBJECTIVE

To examine independent and cumulative effects of sociodemographic, socioeconomic, geographic, and smoking-related factors associated with lung cancer among U.S. adults aged ≥18 years using pooled Behavioral Risk Factor Surveillance System (BRFSS) 2022-2024 data.

METHODS

We conducted a pooled, survey-weighted cross-sectional analysis of BRFSS 2022-2024 to examine factors associated with self-reported lung cancer among U.S. adults aged ≥18 years. Sequential logistic regression models assessed independent and cumulative effects of demographic, socioeconomic, geographic, and smoking-related variables.

RESULTS

In fully adjusted models, lung cancer was associated with female sex (OR = 1.60, 95% CI: 1.17, 2.19), Black race (OR = 2.36, 95% CI: 1.34, 4.17), low income (<$25,000: OR = 2.50, 95% CI: 1.19, 5.26), and residence in the Northeast (OR = 2.39, 95% CI: 1.39, 4.12) and Midwest (OR = 1.95, 95% CI: 1.19, 3.18). Education remained independently associated after smoking adjustment. Heavy and very heavy cumulative smoking exposure showed strongest associations (31-40 pack-years: OR = 3.01; >40 pack-years: OR = 4.40). Adjustment for pack-years attenuated effects of age of smoking initiation, indicating cumulative exposure as the dominant behavioral driver.

CONCLUSIONS

Lung cancer among U.S. adults is strongly patterned by cumulative smoking exposure and persistent socioeconomic and geographic disparities. Prevention should prioritize tobacco exposure reduction alongside structural interventions addressing social disadvantage.