State Disparities in Lung Cancer Screening Uptake Despite Facility Availability in the United States, 2024-2025: A Cross-Sectional Ecological Study
- 1Department of Nutrition and Public Health Sciences, College of Education, Health, and Human Sciences, University of Tennessee, Knoxville, TN, USA
- 2Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, FL, USA
- 3Department of Geography and Sustainability, College of Arts and Sciences, University of Tennessee, Knoxville, TN, USA
Abstract
Introduction: Lung cancer screening (LCS) provides substantial advantages as a secondary prevention strategy, yet screening rates remain low, with notable regional disparities. Our cross-sectional ecological study examined the variations in the density of LCS facilities and the LCS prevalence among at-risk populations across states.
Methods: We used the 2024 Behavioral Risk Factor Surveillance System data to estimate the weighted LCS prevalence among at-risk populations, defined as former/current smokers aged 50-80 years with ≥20 pack-year smoking history. We categorized individuals who had a CT (computed tomography) or CAT (computerized axial tomography) scan for LCS within the past year as having a recommended LCS. The facility list was compiled from the American College of Radiology-LCS Registry accessed in February 2025. The density of LCS facilities, defined as the number of facilities per 100,000 estimated at-risk populations, was employed to account for the varying screening-recommended population sizes in each state.
Results: Vermont had the fewest absolute number of facilities (9), while Florida had the most (669). However, Maine had the lowest LCS facility density (13.3), while D.C. had the highest (65.7) per 100,000 at-risk populations. The LCS prevalence was not significantly correlated with the absolute number (r=0.0144, p=0.9208) or density (r=0.0424, p=0.7698) of LCS facilities, but it significantly varied across states, ranging from 12.1% (95% confidence interval: 8.6%-15.6%) in South Dakota to 29.9% (23.8%-36.0%) in Connecticut.
Conclusions: Our findings reveal that solely increasing the number of LCS facilities, even when accounting for the number of recommended at-risk populations, may not necessarily lead to an increase in LCS prevalence for at-risk populations. A comprehensive geospatial analysis of the distribution of LCS facilities could potentially provide fundamental insights into regional disparities in LCS prevalence by employing the issue of potential spatial mismatches in the arrangement of LCS facilities relative to the geographic distribution of need.
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BibTeX
@article{cho2026state,
title = {{State Disparities in Lung Cancer Screening Uptake Despite Facility Availability in the United States, 2024-2025: A Cross-Sectional Ecological Study}},
author = {Beomyoung Cho and Sericea Stallings-Smith and Hyun Kim},
journal = {Cancer Control: Journal of the Moffitt Cancer Center},
year = {2026},
month = sep,
doi = {10.1177/10732748261494041},
url = {https://doi.org/10.1177/10732748261494041},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - State Disparities in Lung Cancer Screening Uptake Despite Facility Availability in the United States, 2024-2025: A Cross-Sectional Ecological Study
AU - Beomyoung Cho
AU - Sericea Stallings-Smith
AU - Hyun Kim
PY - 2026
DA - 2026/09/28
JO - Cancer Control: Journal of the Moffitt Cancer Center
DO - 10.1177/10732748261494041
UR - https://doi.org/10.1177/10732748261494041
AB - Introduction: Lung cancer screening (LCS) provides substantial advantages as a secondary prevention strategy, yet screening rates remain low, with notable regional disparities. Our cross-sectional ecological study examined the variations in the density of LCS facilities and the LCS prevalence among at-risk populations across states. Methods: We used the 2024 Behavioral Risk Factor Surveillance System data to estimate the weighted LCS prevalence among at-risk populations, defined as former/current smokers aged 50-80 years with ≥20 pack-year smoking history. We categorized individuals who had a CT (computed tomography) or CAT (computerized axial tomography) scan for LCS within the past year as having a recommended LCS. The facility list was compiled from the American College of Radiology-LCS Registry accessed in February 2025. The density of LCS facilities, defined as the number of facilities per 100,000 estimated at-risk populations, was employed to account for the varying screening-recommended population sizes in each state. Results: Vermont had the fewest absolute number of facilities (9), while Florida had the most (669). However, Maine had the lowest LCS facility density (13.3), while D.C. had the highest (65.7) per 100,000 at-risk populations. The LCS prevalence was not significantly correlated with the absolute number (r=0.0144, p=0.9208) or density (r=0.0424, p=0.7698) of LCS facilities, but it significantly varied across states, ranging from 12.1% (95% confidence interval: 8.6%-15.6%) in South Dakota to 29.9% (23.8%-36.0%) in Connecticut. Conclusions: Our findings reveal that solely increasing the number of LCS facilities, even when accounting for the number of recommended at-risk populations, may not necessarily lead to an increase in LCS prevalence for at-risk populations. A comprehensive geospatial analysis of the distribution of LCS facilities could potentially provide fundamental insights into regional disparities in LCS prevalence by employing the issue of potential spatial mismatches in the arrangement of LCS facilities relative to the geographic distribution of need.
SN - 1073-2748
SN - 1526-2359
ER -