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Qian Wang
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MA04 - Health Policy and the Real World (ID 217)
- Event: WCLC 2020
- Type: Mini Oral
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/29/2021, 16:45 - 17:45, Scientific Program Auditorium
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MA04.02 - Lung Cancer Screening Utilization and Its Correlates in Sexual Minorities: An Analysis of the BRFSS 2018 (ID 3133)
16:45 - 17:45 | Author(s): Qian Wang
- Abstract
- Presentation
Introduction
The older lesbians, gays, bisexuals and transgender (LGBT) populations consist of about 400 million people in the U. S. and continue growing. They are facing particular disparities with higher uninsured rates and lower economical and social support. In cancer research, it is established that the LGBT population has significant disparities with higher smoking rates, which is the major risk factor in developing lung cancer, a known malignancy with a low survival rate and poor quality of life. Since lung cancer screening (LCS) can greatly help detect this disease in early stages, a guideline was developed to help identify the population at risk. However, there is no previous data on lung cancer screening in the LGBT population. With higher smoking rates and other outstanding risk factors in this population, in this study, we aimed to examine the social determinants of receiving lung cancer screening and explore potential solutions to eliminate the health disparities in lung cancer.
Methods
Secondary data analysis was conducted using cross-sectional data from U.S. adults aged between 55 and 79 in the Behavioral Risk Surveillance System survey in 2018. The eligible participants for this study are: 1) aged between 55 and 79 years without personal history of lung cancer; 2) provided their gender and sexual orientation identities (who either reported to not know or refused to provide their identities were excluded); and 3) self-identified as former or current smokers. Multivariable logistic regressions were conducted in examining LCS in relation to weighted socioeconomic, health behaviors, and healthcare access factors.
Results
A total of 14.37 % of U.S. individuals aged 55-79 years old who had no personal history of lung cancer were eligible for LCS and among them, approximately 22.85% utilized LCS in the past 12 months. Among the respondents who were assigned males at birth, gay/lesbians (OR: 5.30; 95%CI: 1.32-21.36; p = 0.019), fair/poor general health (OR: 4.16; 95%CI: 1.41-12.26; p = 0.010), and have no medical cost nburden (OR: 9.37; 95%CI: 2.26-38.83; p = 0.002) were significantly associated with greater odds of receiving LCS, whereas bisexual (OR: 0.13; 95%CI: 0.20-0.96; p = 0.045) and heavy drinkers (OR: 0.13; 95%CI: 0.02-0.75; p = 0.023) were associated with less odds of receiving LCS. Among the respondents who were assigned female at birth, fair/poor general health (OR: 4.26; 95%CI: 1.15-15.73; p = 0.030) and have no medical cost burden (OR: 17.00; 95%CI: 2.44-118.23; p = 0.004) were significantly associated with greater odds of LCS.
Conclusion
Our findings point to the potential sex-related and sexual-identity disparities in utilizing LCS among U.S. respondents aged between 55 and 79 years old, using BRFSS data in 2018. Future programs are needed to address the economic burden and increase awareness for the uptake of LCS among bisexual populations, especially among those with assigned male at birth.
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P09 - Health Services Research/Health Economics - Real World Outcomes (ID 121)
- Event: WCLC 2020
- Type: Posters
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P09.19 - Health Disparities Characteristics in Cancer Survivorships among Sexual Minorities in the US - A Cross-Sectional Study Using BRFSS 2018 Data (ID 3738)
00:00 - 00:00 | Author(s): Qian Wang
- Abstract
Introduction
Lesbian, gay, bisexual, and transgender (LGBT) individuals are estimated to be 3.5% of the US population and have unique healthcare disparities when compared to the general population. Previous studies have shown them with increased smoking prevalence, predisposing this group to higher cancer risks, especially for lung cancer, along with worse cancer survivorships. There were other well-studied risk factors such as poorer mental health and BMI over 25, in association with cancer survival outcomes. Cancer survivors who identified as LGBT individuals also had disparities in accessing healthcare, as they bore more burdens socioeconomically and psychologically. In this study, we aimed to elucidate the health disparities in cancer survivorships among LGBT individuals compared to their non-LGBT counterparts, which will help guide healthcare providers in identifying areas of improvement in relating to barriers to cancer care and explore approaches to improve quality of life.
Methods
We conducted a cross-sectional study using the 2018 Behavioral Risk Factor Surveillance System survey data. We used a weighted estimation method for the cancer survivorship model using data from seven states in terms of demographics, health risks, health care access, and cancer survival outcomes. We stratified the data with sexual orientation and gender identity (SOGI) variables to explore potential associations using Chi-Square tests and logistics regression to identify potential health disparities in the LGBT population.
Results
Of the 44,348 sample participants in the study, 1439 were self-identified LGBT. About 91.3% of the heterosexual individuals were over 55 years old, whereas 55.9% in transgender individuals (p<0.0001). Half of the transgender individuals described themselves as persons of color (POC), which was significantly higher than 13.8% of such in the heterosexual group. The bisexual group showed the highest smoking rate of 28.9%, which is doubled compared to heterosexual individuals (p<0.0001). The transgender group showed a significant high binge drinking rate of 20.0%, compared to 8.9% in the heterosexual group. In terms of healthcare access, 33.5% of the transgender individuals did not have healthcare insurance coverage, where only 3.4% of gay/lesbian reported so (p<0.0001). Meanwhile, 35% of bisexual individuals reported having 2 or more types of cancer, where the gay/lesbian group only reported 4.3% (p<0.0001). After adjusting for demographic and healthcare access variables, we found that transgender individuals who assigned male at birth were more likely to have uncontrolled pain caused by cancer and its treatments (OR=7.89, 95%CI[5.98, 10.42]), compared to people who were heterosexual and male at birth. Transgender individuals who assigned female at birth were more likely to have poorer mental health (OR=2.47, 95%CI[2.41, 2.53]), compared to people who were heterosexual and female at birth.
Conclusion
Health disparities in cancer survivors who identified as LGBT individuals showed different characteristics in each SOGI group. Our result indicated potential worse cancer survival outcomes in this population and revealed the possibility of multiple minority stress with disproportionate race/ethnicity data. Future policymakers should focus on expanding healthcare insurance coverage, promoting physical and mental wellbeing regarding cancer status, re-evaluating cancer pain management approaches, and improving programs for tobacco and alcohol control, to adapt to the needs of the LGBT population.
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P41 - Screening and Early Detection - Lung Cancer Screening Programmes (ID 176)
- Event: WCLC 2020
- Type: Posters
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P41.01 - Disparities in Lung Cancer Screening by Baseline Comorbidities: An Analysis of the Behavioral Risk Factor Surveillance System Survey 2018 (ID 3142)
00:00 - 00:00 | Presenting Author(s): Qian Wang
- Abstract
Introduction
Lung cancer screening with low-dose CT scan (LDCT) reduced lung cancer-specific mortality by 15-20% among smokers according to the results from the National Lung Screening Trial and it has been covered by Centers for Medicare and Medicaid Services (CMS) and private insurances in the US. Nevertheless, multiple barriers and disparities still exist in accessing LDCT for those who are eligible and whether having baseline comorbidities would affect accessing lung cancer screening is unclear.
Methods
We performed an analysis using existing cross-sectional data from the U.S. adults aged between 55 – 80 years old who are eligible for lung cancer screening in the Behavioral Risk Surveillance System Survey in 2018. Inclusion criteria: 1) age 55-80 years old; 2) current smoker or former smoker who quitted within 15 years and had more than 30 pack-year smoking history. Exclusion criteria: 1) had baseline history of lung cancer; 2) unknown age or gender. Assessed baseline comorbidity includes myocardial infarction or coronary artery disease, stroke, asthma, COPD, chronic kidney disease, cancer other than lung cancer. Logistic regression models were used to calculate the odds ratio (OR) between receiving LDCT and the number of baseline comorbidity after adjusting for confounders. All calculations were weighted.
Results
Among those who are eligible for lung cancer screening, only 19.7% (95%CI:12.7-26.7%) of the population received LDCT for lung cancer screening. After adjusting for confounders, having 3 or more comorbidities was associated with a higher odd of accessing screening CT compared to those with less or no comorbidity (Table 1), and the magnitude was higher among females than males (OR=36.15, 95% CI:34.80-37.56 vs OR=10.31, 95%CI:9.86-10.78). When stratified by the type of comorbidity, those with any cancer other than lung cancer were 2.32 times (OR=2.32, 95%CI: 2.22-2.43) more likely to have lung cancer screening compared to those without a history of cancer while those with stroke were less likely to receive lung cancer screening (OR=0.61, 95%CI: 0.58-0.63) compared to those without a history of stroke.
ConclusionTable 1. The associations between the number of comorbidities and odds of receiving low-dose lung cancer screening CT (weighted) Prevalence estimate lung cancer screening and column percentage(%) No (80.3%) (Pop size=391,587; N of obs=943) % Yes (19.7%) (Pop size=92,390; N of obs=182) % OR* 95%CI 0 comorbidity 37.4 (29.2-45.5) 95.4 1.8 (0.8-2.8) 4.6
Ref 1 comorbidity 22.6 (16.0-29.1) 84.1 4.2 (2.1-6.4) 15.9 4.17 (4.04-4.30) 2 comorbidities 11.3 (6.3-16.2) 68.4 5.2 (0.0-10.5) 31.6 8.74 (8.46-9.03) 3 or more comorbidities 9.1 (5.0-13.2) 51.9 8.4 (3.5-13.3) 48.1 24.00 (23.29-24.73) *Model adjusted for age, gender, race, education, income, BMI, physical activity, smoking status, and insurance. Abbreviations: OR: odds ratio; CI: confidence interval.
Having multiple comorbidities could potentially foster eligible patients to obtain LDCT for lung cancer screening likely due to more frequent medical visits and discussions with providers. However, a significant disparity exists among participants with different types of comorbidity. Our finding raises the importance of multidisciplinary collaboration in advocating lung cancer screening for those who are eligible, especially patients with less or no comorbidity who may potentially benefit more from lung cancer screening.
