ORIGINAL RESEARCH article
Front. Oncol.
Sec. Thoracic Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1601458
This article is part of the Research TopicTailored Strategies for Lung Cancer Diagnosis and Treatment in Special PopulationsView all 7 articles
Evaluating Lung Cancer Screening Disparities in an Integrated Healthcare System: Barriers and Opportunities.
Provisionally accepted- 1Kaiser Permanente San Francisco Medical Center, San Francisco, United States
- 2Kaiser Permanente Northern California, South San Francisco, California, United States
- 3Division of Research, Kaiser Permanente, Oakland, California, United States
- 4Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, United States
- 5Kaiser Permanente Oakland Medical Center, Oakland, California, United States
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The national average rate of lung cancer screening (LCS) has remained low at roughly 6%, with California ranked lowest (1%) compared to all fifty states (1,2).We enrolled Kaiser Permanente Northern California (KPNC) patients eligible for LCS per the USPSTF guidelines published in 2013 and 2021, respectively. Annual and overall rates of completed initial low-dose computed tomography of chest (LDCT) were computed from February 2015 to February 2022. Chi-squared tests and multivariable Cox regression assessed the impact of sociodemographic factors. The average annual completion rate of initial lung cancer screening over the entire study period was 0.95% per the 2013 USPSTF guidelines. In the year 2022, only 0.69% of all eligible study participants per the 2021 USPSTF guidelines completed lung cancer screening. Chi-squared tests demonstrated differences in the overall proportion of individuals screened across the entire study period stratified by sex and race/ethnicity respectively (2013 USPSTF guidelines; 4.72% Males, 4.29% Females, p = 0.09 for the sex categories and Asian 4.31%, African American 3.89%, Hispanic 3.79%, Other 3.48%, Non-Hispanic White 4.79%, p = 0.02 for the race/ethnicity categories. Multivariate time-to-completion analyses demonstrated statistically significant associations for younger age groups (50-60: HR 1.41, 95% CI 1.21–1.64, p < 0.0001, 61-70: HR 1.95, 95% CI 1.68–2.27, p < 0.0001), male sex (HR 1.17, 95% CI 1.07–1.28, p = 0.0009), and all non-White racial/ethnic groups (Asian: HR 0.73, 95% CI 0.62–0.86, p = 0.0002, African American: HR 0.64, 95% CI 0.53–0.78, p < 0.0001, Hispanic: HR 0.66, 95% CI 0.55–0.80, p < 0.0001, Other: HR 0.75, 95% CI 0.60–0.93, p = 0.0086). Neighborhood Deprivation Index (NDI) quartiles were not significantly associated with initial LDCT completion (HRs 0.93 to 1.04; all p-values > 0.3). This average annual rate of LCS at KPNC was comparable to the statewide average in California. Age 61-70 years old, male sex, and non-Hispanic White race/ethnicity were the strongest and most statistically significant predictors of initial LDCT completion. NDI was not associated with screening uptake. No significant improvement in screening uptake was observed within the first year following the release of the 2021 USPSTF guidelines on LCS.
Keywords: Lung cancer screening, Low dose computed tomography (LDCT), LDCT lung Cancer screening, Integrated healthcare system, Kaiser Permanente, Northern California, Health Disparities, lung cancer
Received: 27 Mar 2025; Accepted: 07 Jul 2025.
Copyright: © 2025 Javier, Jiang, Philippe, Arana and Velotta. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Carmen Javier, Kaiser Permanente San Francisco Medical Center, San Francisco, United States
Jeffrey B Velotta, Kaiser Permanente Oakland Medical Center, Oakland, California, United States
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