Introduction: While previous studies documented variability in lung cancer screening (LCS) based on demographic, socioeconomic, and health related factors, less is known about geographic variation in LCS uptake. Using a nationally representative sample, we examined LCS uptake under the revised 2021 United States Preventive Services Taskforce guidelines according to U.S. Census region and metropolitan status.

Methods: Data were obtained from the 2022 Behavioral Risk Factor Surveillance System. Multivariable logistic regression models were used to examine associations between geographic region and LCS uptake. Stratified analysis was conducted to assess variability in LCS uptake by metropolitan status within each region.

Results: Overall, 17.24% of eligible participants underwent LCS in 2022. LCS uptake was highest in the Northeast (21.95%) followed by the Midwest (17.74%) and the South (16.68%), while the lowest LCS uptake was reported in the West (13.41%). Individuals residing in the South (OR: 0.73; 95% CI: 0.66-0.81), Midwest (OR: 0.78; 95% CI: 0.71-0.86), and West (OR: 0.56; 95% CI: 0.51-0.63) were less likely to undergo LCS than those in the Northeast. LCS uptake was 18% lower among those residing in rural than their urban counterparts (OR: 0.82; 95% CI: 0.76-0.88). In stratified analysis, LCS uptake was significantly lower in rural areas than urban areas within each U.S. census region.

Conclusion: Findings suggest considerable variability in LCS across U.S. geographic regions, with lower uptake in areas with higher lung cancer burden. To reduce lung cancer disparities, geographically targeted interventions to promote LCS may be warranted.

Keywords: Geographic disparities; Low-dose computed tomography; Lung cancer screening.

Copyright © 2025. Published by Elsevier B.V.

简介： 尽管之前的研究记录了基于人口统计学、社会经济和健康相关因素的肺癌筛查（LCS）的变化，但关于地理差异对LCS采用情况的影响了解较少。我们使用全国代表性样本，在美国人口普查区域和地区状况的基础上，根据修订后的2021年美国预防服务工作组指南研究LCS采用情况。

方法： 数据来自2022年行为风险因素监测系统。使用多变量逻辑回归模型来分析地理区域和LCS采用之间的关联。分层分析是在每个区域内根据地区状况评估LCS采用的差异性。

结果： 总体而言，2022年符合条件的参与者中有17.24%进行了肺癌筛查。东北部地区的LCS采用率最高（21.95%），其次是中西部地区（17.74%）和南部地区（16.68%），而西部地区的LCS采用率最低（13.41%）。居住在南部（OR: 0.73；95% CI: 0.66-0.81）、中西部（OR: 0.78；95% CI: 0.71-0.86）和西部（OR: 0.56；95% CI: 0.51-0.63）的个体比居住在东北部地区的个体进行肺癌筛查的可能性更小。与城市居民相比，农村居民的LCS采用率低18%（OR: 0.82；95% CI: 0.76-0.88）。分层分析显示，在每个美国人口普查区域中，农村地区比城市地区的LCS采用率显著较低。

结论： 研究结果表明，美国地理区域之间存在明显的肺癌筛查差异，高肺部疾病负担的地区筛查采用率更低。为了减少肺癌不平等现象，可能需要根据地理位置制定干预措施来推广肺癌筛查。

关键词： 地理差异；低剂量计算机断层扫描；肺癌筛查。