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E. Jackson
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P2.06 - Epidemiology/Primary Prevention/Tobacco Control and Cessation (ID 707)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Epidemiology/Primary Prevention/Tobacco Control and Cessation
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.06-008 - Diagnosis of Incidental Disease in Medicaid Recipients During Lung Cancer Screening (ID 10211)
09:30 - 09:30 | Author(s): E. Jackson
- Abstract
Background:
The National Lung Screening Trial (NLST) reported reduced all-cause and lung cancer- specific mortality among patients screened for lung cancer with low-dose computed tomography (LDCT). NLST subgroup analyses have shown even greater mortality reductions among socioeconomically disadvantaged racial minorities due to abnormalities other than pulmonary nodules discovered on LDCT. These incidental findings (IFs) often represent clinically significant undiagnosed disease in socioeconomically disadvantaged individuals. In early 2015, the Center for Medicare/Medicaid Services (CMS) added lung cancer screening as a preventive service benefit, which led to the widespread implementation of lung cancer screening programs across the country. Our study aims to quantify the association between insurance type, and the discovery of clinically significant undiagnosed disease on LDCT in high-risk smokers.
Method:
This retrospective cohort study provides a preliminary analysis of electronic health record data from The Ohio State University Lung Cancer Screening Program from September 2016 (when Medicaid coverage for lung cancer screening took effect) to March 2017. Eligible participants met CMS criteria for annual lung cancer screening with LDCT. The outcome of interest was major IFs discovered on LDCT (e.g. coronary artery disease, vascular disease, emphysema) not previously identified in the patient’s medical history. Logistic regression analysis was conducted to estimate odds ratios (ORs) to quantify the association between insurance type (Medicaid, Medicare/VA and private) and new incidental diagnosis (yes/no) adjusting for age, gender, race, and smoking history.
Result:
Data from130 patients who had a first-time lung cancer screening were analyzed. Two-thirds of participants were male, 39% were non-white and 57% were current smokers, with mean age of 63 years (SD=5.4). Almost 20% of participants (n=25) received Medicaid, 42% received Medicare/VA (n=54) and 38% had private insurance (n=49). Multivariable logistic regression analysis revealed that the odds of new incidental diagnoses were 8 times higher for patients with Medicaid versus private insurance (OR=8.0; 95%CI=2.6,24.9; p<0.001). The odds for IF were 3.5 times higher when comparing Medicaid versus Medicare/VA (OR=3.5; 95%CI=1.0,11.9; p=0.0430). Covariates age and race were significantly associated with a new IF (OR=2.9; 95%CI=1.03,8.4; p=0.0432 for age and OR=2.5; 95%CI=1.1,5.8; p=0.0328 for race), but gender and smoking history were not statistically significant.
Conclusion:
These results demonstrate increased clinically significant previously unidentified IFs among Medicaid-insured high-risk smokers, and suggest that LDCT lung cancer screening could provide an opportunity for secondary prevention by diagnosing occult disease in socioeconomically disadvantaged individuals. We will continue to monitor these data as more patients are screened and sample size is increased.
