Access and adherence to low-dose CT-based lung cancer screening in an urban, safety-net population
Introduction
Recent modifications to low-dose computed tomography (LDCT)-based lung cancer screening guidelines increases the number of eligible individuals, particularly among racial and ethnic minorities. Because these populations disproportionately live in metropolitan areas, we analyzed the association between location, transportation, and LDCT completion within an integrated, urban safety-net healthcare system.
Methods
Using ESRI’s StreetMap Premium, OpenStreetMap, and r5r package in R, we determined projected personal vehicle and public transportation travel times between patient residence and the LDCT facility for LDCT ordered between March 2017 and December 2022 at Parkland Health in Dallas County, Texas. We used univariable analysis to characterize the association between projected travel time and LDCT completion.
Results
A total of 2,287 patients were included in the analysis. Mean age was 63 years; 73% were under-represented minorities (URM). Median distance between patient home and LDCT facility was 10.7 miles. Median travel time was 17 minutes by personal vehicle and 67 minutes by public transportation. Overall, 1,553 (68%) of ordered LDCT were completed. There was a small difference in public transportation travel time between completed and not completed LDCT (67 versus 65 minutes; P=0.04) but not for personal vehicle travel time (17 minutes for completed and non-completed LDCT; P=0.66). In multivariable analysis, LDCT completion was not associated with projected travel time (personal vehicle HR=1.001; P=0.90; public transportation HR=1.003; P=0.15).
Conclusion
In a predominantly URM urban population, projected travel time is not associated with LDCT completion at a single, centralized facility.