Delaying Screening Until Covered? Changes in Lung Cancer Screening at the Age of Nearly-Universal Medicare Insurance.

OBJECTIVE

To estimate changes in lung cancer screening at age 65, the age of nearly universal Medicare coverage.

STUDY SETTING AND

DESIGN

Screening reduces lung cancer mortality but is underutilized. We used a regression discontinuity design to measure the impact of nearly universal Medicare coverage at age 65 on first-time receipt of screening (primary outcome) and the proportion of screened individuals with detected lung cancer (secondary outcome).

DATA SOURCES AND ANALYTIC SAMPLE: First-time screens at age 60-69 in the American College of Radiology's Lung Cancer Screening Registry data, 2015-2020.

PRINCIPAL FINDINGS: Nearly-universal access to Medicare at 65 increased first-time lung cancer screening by 5450 per year (CI 4911-5990), a 41% increase compared to age 64. Eighty-nine percent of additional screens were among people who met screening eligibility criteria. Increases at age 65 were larger in rural areas than nonrural areas (52% vs. 39%) and were similar for men and women (41% and 42%). There was no statistically significant change in the proportion of screened individuals with lung cancer detected.

CONCLUSION

First-time receipt of lung cancer screening increases at age 65, particularly among people in rural areas. Cancer detection rates did not worsen, suggesting screening remained well targeted as it increased.