目的:本研究使用2013年美国预防服务工作组(USPSTF)低剂量计算机断层扫描(LDCT)肺癌指南和修订的2021年指南,研究了肺癌筛查合格率的种族/族裔差异。
方法:本研究通过分析健康与退休研究(HRS)的数据,采用回顾性和横断面研究设计。N=2,823名年龄在50-80岁的自我报告当前吸烟的受访者被纳入分析。在调整了受访者的人口统计学特征后,根据修订后的2021年指南,进行了二元逻辑回归分析,以检查LDCT筛查资格的变化状态。
结果:我们的研究发现,当比较原始指南和修订指南时,不同种族和族裔群体的筛选合格率显著增加。增长最大的是黑人(174%),西班牙裔(152%),其他类别的(118%),吸烟的白人(80.8%)。在将原始筛查指南与修订后的指南进行比较时,吸烟的白人从“不合格”到“合格”的变化比例最高(28.3%),其次是“其他”类别的个人(28.1%),黑人(23.2%)和西班牙裔吸烟(18.3%)(p<0.001)。二元Logistic回归结果进一步显示,吸烟的黑人(OR=0.71,p=0.001),以及吸烟的西班牙裔(OR=0.54,p<0.001),与采用修订后的筛查指南后吸烟的白人相比,不太可能从不合格变为合格筛查。根据白人和其他种族/族裔群体之间筛查合格率的绝对差异,根据新的指导方针,差距可能会扩大,特别是在白人之间观察到较大的绝对差异,黑人,和西班牙裔。
结论:我们的研究强调了目前吸烟人群中LDCT筛查资格的种族/民族差异。虽然修订后的USPSTF指南增加了对种族和族裔少数群体的筛查资格,他们没有消除这些差距,根据新的指导方针,他们可能已经扩大。有针对性的干预措施和政策对于解决代表性不足人群面临的障碍和促进公平获得肺癌筛查是必要的。
OBJECTIVE: This study examined racial/ethnic disparities in lung cancer screening eligibility rates using 2013 US Preventive Services Task Force (USPSTF)
guidelines for lung cancer with low-dose computed tomography (LDCT) and the revised 2021
guidelines.
METHODS: The study utilized a retrospective and cross-sectional research design by analyzing data from the Health and Retirement Study (HRS). N = 2,823 respondents aged 50-80 who self-reported current smoking were included in the analyses. Binary logistic regression analysis was conducted to examine the changed status of LDCT screening eligibility based on the revised 2021 guidelines by race/ethnicity after adjusting for respondent demographics.
RESULTS: Our study found substantial increases in screening eligibility rates across racial and ethnic groups when comparing the original and revised guidelines. The largest increase was observed among Black people (174%), Hispanics (152%), those in the other category (118%), and Whites who smoke (80.8%). When comparing original screening
guidelines to revised
guidelines, Whites who smoke had the highest percentage of changes from \"not eligible\" to \"eligible\" (28.3%), followed by individuals in the \"other\" category (28.1%), Black people (23.2%) and Hispanics who smoke (18.3%) (p < 0.001). Binary logistic regression results further showed that Black people who smoke (OR = 0.71, p = 0.001), as well as Hispanics who smoke (OR=0.54, p < 0.001), were less likely to change from not eligible to eligible for screening compared to Whites who smoke after adopting the revised screening guidelines. Based on the absolute differences in screening eligibility rates between Whites and other racial/ethnic groups, the disparities may have widened under the new guidelines, particularly with larger absolute differences observed between Whites, Black people, and Hispanics.
CONCLUSIONS: Our study highlights racial/ethnic disparities in LDCT screening eligibility among people who currently smoke. While the revised USPSTF
guidelines increased screening eligibility for racial and ethnic minorities, they did not eliminate these disparities and may have widened under the new
guidelines. Targeted interventions and policies are necessary to address barriers faced by underrepresented populations and promote equitable access to lung cancer screening.