Bivariate Spatial Pattern between Smoking Prevalence and Lung Cancer Screening in US Counties

Bian Liu, Jeremy Sze, Lihua Li, Katherine A. Ornstein and Emanuela Taioli
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Bian Liu: Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
Jeremy Sze: Department of Population Health, Division of Health & Behavior, Section on Health Choice, Policy & Evaluation, New York University School of Medicine, New York, NY 10016, USA
Lihua Li: Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
Katherine A. Ornstein: Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
Emanuela Taioli: Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA

IJERPH, 2020, vol. 17, issue 10, 1-10

Abstract: Objectives: Lung cancer screening (LCS) with low-dose computed tomography (LDCT) has been a reimbursable preventive service covered by Medicare since 2015. Geographic disparities in the access to LDCT providers may contribute to the low uptake of LCS. We evaluated LDCT service availability for older adults in the United States (US) based on Medicare claims data and explored its ecological correlation with smoking prevalence. Materials and Methods: We identified providers who provided at least 11 LDCT services in 2016 using the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File. We constructed a 30-mile Euclidian distance buffer around each provider’s location to estimate individual LDCT coverage areas. We then mapped the county-level density of LDCT providers and the county-level prevalence of current daily cigarette smoking in a bivariate choropleth map. Results: Approximately 1/5 of census tracts had no LDCT providers within 30 miles and 46% of counties had no LDCT services. At the county level, the median LDCT density was 0.5 (interquartile range (IQR): 0–5.3) providers per 1000 Medicare fee-for-service beneficiaries, and cigarette smoking prevalence was 17.5% (IQR: 15.2–19.8%). High LDCT service availability was most concentrated in the northeast US, revealing a misalignment with areas of high current smoking prevalence, which tended to be in the central and southern US. Conclusions: Our maps highlight areas in need for enhanced workforce and capacity building aimed at reducing disparities in the access and utilization of LDCT services among older adults in the US.

Keywords: low-dose computed tomography; cigarette smoke exposure; health disparities; medicare; cancer screening (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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