Rural-urban disparities in lung cancer screening and outcomes: A comprehensive study of Texas counties.

Abstract

e13528 Background: Lung cancer is the second most common and the first most deadly cancer in the United States. While lung cancer cases have declined in recent years, significant rural-urban disparities in outcomes and access to screening persist. Texas has the largest rural and the second largest urban population in the country, making it a useful case study for examining these geographical differences. This study explores 1) the relationship between lung cancer rates, rurality, and various non-medical drivers of health and 2) the statewide geospatial distribution of lung cancer screening sites. Methods: Data for all 254 Texas counties on lung cancer all-stage incidence, late-stage incidence, and deaths per 100,000 residents were extracted from the National Cancer Institute State Cancer Profiles website. County-level rurality was classified using the U.S. Department of Agriculture 2023 Rural-Urban Continuum Codes. Covariate data for each county, including proportion of uninsured, racial/ethnic minority, people living below 150% of the federal poverty level, and current smokers were obtained from the 2017-2021 American Community Survey and the 2019 Centers for Disease Control PLACES platform. Multiple linear regression modeling was used to analyze the association between rurality, lung cancer data, and covariates. To explore the spatial distribution of screening sites, facility addresses were taken from the American College of Radiology Lung Cancer Screening Registry and geocoded using ArcGIS. Results: Rurality was inversely associated with all-stage incidence (p = 0.03), suggesting that urban counties have higher rates of lung cancer. Current smoking prevalence was directly correlated with all-stage incidence, late-stage diagnosis, and mortality (p < 0.0001), as was percent below 150% of the poverty level (p < 0.05). Conversely, the proportion of racial/ethnic minority was inversely associated with all three (p < 0.0001). Texas has 100 screening sites, which are clustered within 30 of its 254 counties. Of these facilities, only 4 are located within rural counties. Notably, 37% of individuals 50-80 years old, the age-eligible population for screening, reside in a county without a screening site. Conclusions: This study highlights the key influence of social and geographical factors on lung cancer trends. While rurality was not associated with increased incidence or mortality, it does significantly impact older adults’ access to screening. Interventions that improve screening availability and care, particularly within rural counties with high rates of poverty and smoking, are essential to reducing disparities and bettering outcomes.