National Survey of Lung Cancer Screening Eligibility in United States Veterans.

Abstract

Introduction: Lung cancer screening is underutilized, especially in rural areas where lung cancer mortality is high. Approximately 11.2% of the United States (US) population over age 50 meet the United States Preventive Services Task Force (USPSTF) 2021 lung cancer screening eligibility criteria; the proportion of eligible Veterans is unknown. This study evaluated the proportion of Veterans who are USPSTF-eligible and tested the hypothesis that more USPSTF-2021-eligible Veterans reside in rural versus non-rural areas.

Methods: Investigators cross-sectionally surveyed a national sample of Veterans age 50 years and older January-November 2022. Oversampling ensured inclusion of minority groups and accounted for geographic variation in tobacco use. Analyses in 2023-2024 evaluated the proportion of USPSTF-eligible Veterans by year (2013 and 2021) and tested USPSTF-2021 eligibility by rural status (rural vs non-rural) using Chi square tests. Weighting accounted for survey non-response and applied results to the whole Veteran population in a sensitivity analysis.

Results: Of 2,000 surveyed, 754 responded (37.7% response rate); most respondents were White (74.4%), male (92.6%), resided in non-rural areas (66.0%). Proportions meeting USPSTF criteria were 35.5% (95% CI 31.6-39.6%) in 2021 and 27.8% (95%CI 24.3-31.7%) in 2013. The proportion of USPSTF-2021-eligible rural Veterans (41.2%;95%CI 34.8-48.0%) was higher compared with non-rural (32.5%;95% CI 27.7-37.7%), P=0.037. A sensitivity analysis found the proportion of Veterans USPSTF-2021-eligible in the whole population was 33.0%.

Conclusions: The proportion of Veterans USPSTF-2021-eligible was nearly three times higher than the general US population (11.2%), and a greater proportion of eligible Veterans resided in rural compared with non-rural areas. These findings are critical for policies aimed at fully implementing lung cancer screening at scale.