Early detection of lung cancer reduces cancer mortality; yet uptake for lung cancer screening (LCS) has been limited in Washington State. Geographic disparities contribute to low uptake, but do not wholly explain gaps in access for underserved populations. Other factors, such as an adequate workforce to meet population demand and the capacity of accredited screening facility sites, must also be considered. What proportion of the eligible population for LCS has access to LCS facilities in Washington State? We used the enhanced two-step floating catchment area (E2SFCA) model to evaluate how geographic accessibility in addition to availability of LCS imaging centers contribute to disparities. We used available data on radiologic technologist volume at each American College of Radiology (ACR)-accredited screening facility site to estimate the capacity of each site to meet potential population demand. Spearman rank correlation coefficients of the spatial access ratios were compared with the 2010 Rural-Urban Commuting Area (RUCA) codes and area deprivation index quintiles to identify characteristics of populations at risk for lung cancer with greater and lesser levels of access. A total of 549 radiologic technologists were identified across the 95 ACR-accredited screening facilities. We observed that 95% of the eligible population had proximate geographic access to any ACR facility. However, when we incorporated the E2SFCA method, we found significant variation of access for eligible populations. The inclusion of the availability measure attenuated access for most of the eligible population. Furthermore, we observed that rural areas were substantially correlated, and areas with greater socioeconomic disadvantage were modestly correlated, with lower access. Rural and socioeconomically disadvantaged areas face significant disparities. The E2SFCA models demonstrated that capacity is an important component and how geographic access and availability jointly contribute to disparities in access to LCS.

中文翻译：

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分两步了解华盛顿州肺癌筛查率低：对患者出行时间和成像站点的医疗保健可用性进行地理空间分析


早期发现肺癌可降低癌症死亡率；然而，华盛顿州对肺癌筛查 (LCS) 的接受程度有限。地理差异导致了使用率低，但并不能完全解释服务不足人群获取服务的差距。还必须考虑其他因素，例如满足人口需求的充足劳动力以及经认可的筛查设施场所的能力。符合 LCS 资格的人口中有多少比例可以使用华盛顿州的 LCS 设施？我们使用增强型两步浮动集水区（E2SFCA）模型来评估地理可达性以及濒海战斗舰成像中心的可用性如何造成差异。我们使用美国放射学院 (ACR) 认可的每个筛查机构站点的放射技术人员数量的现有数据来估计每个站点满足潜在人口需求的能力。将空间访问比率的 Spearman 等级相关系数与 2010 年城乡通勤区 (RUCA) 代码和区域剥夺指数五分位数进行比较，以确定具有较高和较低访问水平的肺癌风险人群的特征。在 95 个 ACR 认可的筛查机构中，总共确定了 549 名放射技术人员。我们观察到，95% 的符合条件的人群可以在附近的地理区域访问任何 ACR 设施。然而，当我们纳入 E2SFCA 方法时，我们发现符合条件的人群的访问权限存在显着差异。纳入可用性衡量标准削弱了大多数符合条件的人口的获取机会。此外，我们观察到农村地区存在显着相关性，而社会经济劣势较大的地区则存在适度相关性，且访问机会较低。 农村和社会经济弱势地区面临着巨大的差距。 E2SFCA 模型表明，容量是一个重要组成部分，以及地理访问和可用性如何共同导致 LCS 访问方面的差异。