Spatial access to screening centers and late-stage lung cancer in Alabama.

Abstract

130 Background: Cancer stage at diagnosis has a tremendous influence on type of treatment, recovery and survival. This study examined the impact of spatial access to healthcare services on late-stage lung cancer diagnosis in Alabama, taking into account access and travel time to the nearest Screening Center of Excellence (SCOE). Methods: A cross-sectional retrospective study of lung cancer incidence in the state of Alabama was employed, using zipcode as unit of analysis. Data on individual lung cancer diagnosis between 2013 and 2018 was obtained from Alabama State Cancer Registry. Geographic information system (GIS) network analysis was used to calculate distance to the nearest SCOE. Descriptive statistics were used to compare distribution of independent variables including residential status, age, race, gender and insurance across lung cancer diagnosis stage. Multi-variable logistic regression assessed odds ratio and 95% confidence intervals to evaluate the relationship between residential status and late-stage diagnosis. Results: 14,556 individuals were diagnosed with lung cancer in Alabama from 2013 - 2018. Late-stage diagnosis accounted for 72.7% of cases, predominantly among males (56.5%) and Whites (79.8%). Late-stage vs. early-stage cases differed significantly in sex (males: 59.2% vs. 50.9%) and race (Whites: 78.6% vs. 83.4%) (p < 0.0001). Multivariable logistic regression analyses found that Alabamians were more likely to be diagnosed with late stage lung cancer if they were Black (p < 0.0001); male (p < 0.0001); uninsured (p < 0.0001); and/or insured via Medicaid (p < 0.0001). Alabamians were less likely to be diagnosed with late stage lung cancer if they were within 60 miles of a SCOE (p < 0.0001). Living in a persistent poverty census tract was associated with a lower OR for late-stage lung cancer occurrence (adjusted OR = 0.88, 95% CI =0.78-0.99, p=0.0341). Neighborhood Deprivation Index did not significantly correlate with late-stage lung cancer (p = 0.8280). Conclusions: Proximity to screening centers within 60 miles is associated with a reduced likelihood of late-stage lung cancer. Additionally, race, sex, insurance status, and age are significant factors. These findings underscore the importance of access to screening centers and the influence of demographic and socioeconomic factors on lung cancer stage at diagnosis.