What question did this study set out to answer?

To assess the impact of USPSTF lung cancer screening guidelines on disparities in diagnosis and survival based on income levels.

May 29, 2026

Trends in income-related lung cancer disparities since the introduction of USPSTF screening guidelines.

Key Points

To assess the impact of USPSTF lung cancer screening guidelines on disparities in diagnosis and survival based on income levels.
Analysis of national US data from SEER 21 Registries (2005-2022)
Cox proportional hazards model used to evaluate survival outcomes based on area income levels
Comparison of lung cancer stage at diagnosis and survival rates before and after screening guidelines introduction.
Lung cancers detected at a localized stage increased by 24.6% in the lowest income group and 37.5% in the highest income group post-2013.
Median survival increased across all income groups, with the highest income showing a greater positive association.
Income-related survival disparity increased by 12.2% in the period of 2014-2022 compared to 2005-2013 (HR = 1.122, p < 0.001).

Abstract

8072 Background: In 2013, the USPSTF introduced guidelines for lung cancer screening to promote earlier detection. Prior screening programs have unintentionally widened disparities due to limited access in vulnerable populations. We examined national US administrative data to explore the effect of lung cancer screening according to area levels of income. Methods: We studied adults with lung cancer in the SEER 21 Registries Database diagnosed between 2005-2022 over two time periods (pre-screening: 2005-2013; screening: 2014-2022). We evaluated outcomes of survival and stage distribution over varied levels of county median household income (MHI). We calculated descriptive statistics for our sample and used a Cox PH model to evaluate the interaction of time period and MHI while adjusting for other covariates. Results: We identified 485, 763 cases in the pre-screening era and 487, 001 cases in the screening era, with the median age for each group in the 60-69 years range. Sex, race, rurality, MHI and stage are reflective of US lung cancer demographics. Compared to the pre-screening era, cases in the screening era were more likely to be diagnosed at a localized stage in all MHI groups. The lowest MHI group saw a 24. 6% increase in proportion of cases detected at a localized stage, while the highest MHI group saw a 37. 5% increase. Median survival increased for all MHI groups with a positive association between MHI and survival gains. In a multivariable Cox PH model, a time period and MHI interaction term indicated that the income-related survival disparity between the highest and lowest MHI groups is 12. 2% larger in 2014-2022 than in 2005-2013 (HR = 1. 122, p < 0. 001). Conclusions: Since the introduction of USPSTF lung cancer screening guidelines in 2013, lung cancers are detected at earlier stages and survival has improved. These changes have been experienced across all income groups, but the income-related disparities in survival have widened. These results indicate a need for additional efforts to ensure that the benefits of lung cancer screening are distributed across all populations regardless of wealth. MHI Year of Diagnosis 3-Year OS 5-Year OS Median OS (Months) Change in Median OS (Months) < 60, 000 2005-2013 19. 4% (19. 2-19. 6) 13. 8% (13. 6-14. 0) 8 (7. 89-8. 11) 2 2014-2022 25. 5% (25. 1-25. 9) 18. 3% (17. 9-18. 7) 10 (9. 84-10. 16) 60, 000 - 69, 999 2005-2013 21. 8% (21. 6-22. 0) 15. 9% (15. 7-16. 1) 9 (8. 88-9. 12) 2 2014-2022 29. 2% (28. 8-29. 6) 21. 8% (21. 4-22. 2) 11 (10. 80-11. 20) 70, 000 - 79, 999 2005-2013 22. 6% (22. 4-22. 8) 16. 7% (16. 5-16. 9) 9 (8. 89-9. 11) 4 2014-2022 31. 4% (31. 0-31. 8) 23. 9% (23. 5-24. 3) 13 (12. 78-13. 22) 80, 000 - 99, 999 2005-2013 23. 9% (23. 7-24. 1) 17. 7% (17. 5-17. 9) 9 (8. 87-9. 13) 6 2014-2022 33. 8% (33. 4-34. 2) 25. 8% (25. 4-26. 2) 15 (14. 77-15. 24) ≥ 100, 000 2005-2013 27. 3% (26. 9-27. 7) 20. 6% (20. 2-21. 0) 11 (10. 81-11. 19) 8 2014-2022 38. 6% (38. 2-39. 0) 30. 1% (29. 7-30. 5) 19 (18. 66-19. 35)

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