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A5974 - Assessing the Implications of Average Household Income on Adherence to Lung Cancer Screening Recommendations
Author Block: F. Genese1, S. Kuperberg2, C. R. Bellinger3; 1Pulmonary / Critical Care, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States, 2Chicago Chest Center, Elk Grove Village, IL, United States, 3Pulmonary Critical Care, North Carolina Baptist Hosp, Winston Salem, NC, United States.
RATIONALE: The National Lung Screening Trial (NSLT) established that yearly low-dose screening CT scans reduce lung cancer mortality compared to CXR in high risk individuals. Observational studies have demonstrated that adherence to cancer screening is influenced by various demographic factors, including age, gender, and education. We assessed the implications of average household income on adherence to follow-up for lung cancer screening. METHODS: 268 individuals eligible for annual lung cancer screening underwent a baseline CT scan from September 2014 to March 2016. Adherence to follow-up was defined by completing follow-up imaging and/or biopsy within 30 days of the expected date, which was determined by Lung-RADS (lung imaging reporting and data system). Regression-based analyses were based on average household income adjusted by age, smoking pack-years, gender, and lung-RADS category. Average household income was determined via zip code of the subject’s primary residence. RESULTS: Our cohort had an average age of 68 and consisted of 133 females (49.6%) and 135 males (50.4%). Average pack-years was 48.9 with most subjects being active smokers (N=168, 62.7%).The average household income was $60,656 with 177 (66%) making less than $60K, while only 11 (4%) had an average household income greater than $100K. 200 (74.6%) were not adherent to follow-up imaging/biopsy within 30 days of the expected date. Males tended to be more noncompliant than females (N=107[79.3%] vs N=93[70.0%], p=0.08). Nonadherence to follow-up was unrelated to age (63.9 vs 64.47 years, p=0.57) or active smoking status (64.5% vs 57.35%, p=0.29) when compared to those that were adherent. Of the 268 baseline CT scans used for lung cancer screening, 226 (84.3%) were categorized as lung-RADS 1/2. Compliance with follow-up was significantly associated with lung-RADS classification on baseline CT scan (22% compliance rate for lung-RADS 1/2 vs 45% for lung-RADS 3/4, p=0.0002). Subjects with average household incomes greater than $80K (N=42) had a compliance rate of 33.3%, whereas those with incomes less than $50K (N=66) were 17.9% compliant with follow-up imaging/biopsy. When adjusted for age, smoking pack-years, gender, and lung-RADS category, subjects with an average household income greater than $60K had a significantly higher adherence rate compared to those with incomes less than $60K (31.87% vs 22.03%, p=0.02). CONCLUSION: We found that higher average household incomes were associated with better adherence to follow-up for lung cancer screening. In order to enhance the effectiveness of lung cancer screening, clinicians need to be cognizant of socio-economic factors in their patient population.