Census Tract Rurality, Predominant Race and Ethnicity, and Distance to Lung Cancer Screening Facilities : An Ecological Study.

BACKGROUND

The U.S. Preventive Services Task Force recommends annual lung cancer screening (LCS) for adults who meet specific age and smoking history criteria.

OBJECTIVE

To evaluate race-, ethnicity-, and rurality-based differences in distance to the nearest LCS facility.

DESIGN

Cross-sectional ecological study.

SETTING

U.S. census tracts.

PARTICIPANTS

71 691 census tracts.

MEASUREMENTS: The outcome variable was road network distance in miles between a census tract and the nearest LCS facility. Distance was log-transformed, and geometric means are reported. Census tracts were classified as majority (>50%) American Indian/Alaska Native (AI/AN), Asian, Black, non-Hispanic White (NHW), no single race, or Hispanic. Rurality was defined using the rural-urban commuting area codes. Ordinary least-squares regression examined the associations between distance and census tract race, ethnicity, and rurality.

RESULTS

Geometric mean distance to the nearest LCS facility was 6.5 miles. Compared with NHW-majority census tracts, distance to the nearest LCS facility was 5.26 times (426%) longer in AI/AN-majority census tracts and 7% to 39% shorter in Asian-, Black-, and Hispanic-majority census tracts. Adjustment for rurality reduced the mean distance in AI/AN-majority census tracts, but the mean distance was still 3.16 times the distance in NHW-majority census tracts. Adjustment for rurality reduced the observed advantage in Asian- and Black-majority census tracts and changed the direction of associations in Hispanic-majority census tracts.

LIMITATION: Analyses did not account for travel time or cost.

CONCLUSION

Differences exist in distance to LCS facilities by race and ethnicity that can only be partially explained by rurality.

PRIMARY FUNDING SOURCE: Lung Ambition Alliance and the Center for Lung Research in Honor of Wayne Gittinger.