The association of urbanicity and travel time with lung cancer screening utilization

Ezinne Sylvia Melikam; Virginia Simmons; Elham Masoomkhah; Regina Franco; Kathleen B Cartmell; Rachel Mayo; Ronald Gimbel; Marvin Okon; Lu Zhang

doi:10.1016/j.canep.2023.102396

The association of urbanicity and travel time with lung cancer screening utilization

Cancer Epidemiol. 2023 Aug:85:102396. doi: 10.1016/j.canep.2023.102396. Epub 2023 Jun 7.

Authors

Ezinne Sylvia Melikam¹, Virginia Simmons², Elham Masoomkhah³, Regina Franco⁴, Kathleen B Cartmell¹, Rachel Mayo¹, Ronald Gimbel¹, Marvin Okon¹, Lu Zhang⁵

Affiliations

¹ Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA.
² Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA; Center for Integrative Oncology & Survivorship, Prisma Health, 900 W Faris Rd 1st Floor, Greenville, SC 29605, USA.
³ Clemson Center for Geospatial Technologies, Clemson University Libraries, 116 Sigma Drive, Clemson, SC 29634, USA.
⁴ Center for Integrative Oncology & Survivorship, Prisma Health, 900 W Faris Rd 1st Floor, Greenville, SC 29605, USA.
⁵ Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA. Electronic address: lz3@clemson.edu.

PMID: 37290246
DOI: 10.1016/j.canep.2023.102396

Abstract

Background: To examine 1) the rate of lung cancer screening (LCS) utilization in a large healthcare system in South Carolina; 2) associations of urbanicity and travel time with LCS utilization.

Methods: LCS-eligible patients from 2019 were identified. The outcome was LCS utilization. The exposures were zip-code level urbanicity and travel time from the centroid of zip-code area to the nearest screening site (<10,10-<20, ≥20 min). Covariates included age, sex, race, marital status, insurance, body mass index, chronic obstructive pulmonary disease, Charlson Comorbidity Index (0, 1, 2, ≥3), and zip-code level median income. Chi-square tests and logistic regressions were employed.

Results: The analysis included 6930 patients, among whom 1432 (20.66%) received LCS. After adjusting for covariates, living in a non-metropolitan area (adjusted odds ratio: 0.32; 95% confidence interval: 0.26-0.40) and having longer travel time (0.80 [0.65-0.98] and 0.68 [0.54-0.86] for 10-<20 and ≥20 min travel time, respectively, compared to <10 min travel time) were significantly associated with lower odds of LCS utilization.

Conclusions: The LCS utilization rate of a healthcare system was about 20% in 2019. Living in non-metropolitan areas or having longer travel time to LCS site were associated with lower LCS utilization.

Keywords: Electronic health records; Lung cancer screening; Metropolitan areas; Travel time.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Early Detection of Cancer*
Humans
Income
Lung Neoplasms* / diagnosis
Lung Neoplasms* / epidemiology
Mass Screening
South Carolina / epidemiology
Travel