Abstract C162: Racial and ethnic differences in COPD clinical phenotypes and their association with lung cancer screening utilization

Abstract Background: Patients with mild to moderate Chronic Obstructive Pulmonary Disorder (COPD) are more likely to benefit from lung cancer screening (LCS), whereas those with severe COPD face increased risk of downstream procedural complications and competing causes of death. This study aimed to evaluate the likelihood of patients from different racial and ethnic groups belonging to specific COPD clinical phenotypes and to examine LCS utilization by phenotype severity, among individuals with COPD who are eligible for LCS. Methods: This retrospective analysis included 39,030 individuals diagnosed with COPD who met LCS eligibility criteria based on age (50-80 years) and smoking history (current or former smoking status), identified between 2016 and 2023 at the University of Florida. Latent class analysis (LCA) was used to identify COPD clinical phenotypes based on demographic characteristics, comorbidities, COPD medications, and number of admissions, which were then categorized by severity. Multinomial logistic regression assessed the likelihood of racial and ethnic groups belonging to specific COPD phenotypes, while adjusting for rurality, educational attainment, and smoking status. Binomial logistic regression evaluated the odds of LCS utilization by COPD phenotype, using the moderate phenotype as the reference. Results: The mean age was 64.4 years and 50.2% were male, with a racial/ethnic composition of 77.6% Non-Hispanic White, 17.0% Non-Hispanic Black, 2.4% Hispanic, and 3% Other. The LCS rate was 7.3%. LCA identified five COPD clinical phenotypes categorized as minimal, mild, moderate, severe, and very severe based on the posterior probability distribution of the LCA variables. After adjusting for sociodemographic covariates, Non-Hispanic Black (OR: 2.36; 95% CI: 2.17, 2.59) and Hispanic patients (OR: 1.56; 95% CI: 1.23, 1.97) were more likely to belong to the very severe phenotype compared to Non-Hispanic White patients, using the moderate phenotype as the reference. In binomial logistic regression, individuals with the very severe phenotype had higher odds of undergoing LCS compared to the moderate phenotype (odds ratio OR: 2.07; 95% Confidence Interval CI: 1.85, 2.31). Conclusions: Although individuals with the very severe COPD phenotype demonstrated higher odds of undergoing LCS, Non-Hispanic Black and Hispanic patients were disproportionately more likely to belong to this phenotype. This finding raised concerns about potential overscreening in populations less likely to benefit due to increased procedural risks and competing causes of death. Developing personalized LCS strategies that integrate COPD severity and account for racial and ethnic disparities in phenotype distribution is critical to ensuring equitable and effective screening practices. Citation Format: Caretia J. Washington, Shama D. Karanth, Gerard A. Silvestri, Dejana Braithwaite. Racial and ethnic differences in COPD clinical phenotypes and their association with lung cancer screening utilization abstract. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C162.