Geographic Access to Low-Dose CT Lung Cancer Screening in Tennessee: Disparities by Socioeconomic Variables, Rurality, and Appalachian Status

IF 3.2 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health Pub Date : 2026-08-08 DOI:10.1111/jrh.70202

Sima Namin, Martin Whiteside, R. Eric Heidel, Jonathan S. Wall, Jennifer Ferris, Rajiv Dhand

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Abstract

Introduction

Lung cancer screening enables earlier detection and improved outcomes, yet geographic inequities persist in access to low-dose computed tomography (LDCT). We quantified tract-level access to LDCT screening in Tennessee and examined disparities by rurality and Appalachian status.

Methods

We compiled an inventory of LDCT-capable sites and measured access using a 30-min enhanced two-step floating catchment area (E2SFCA) index with three banded decay weights. Access was compared across four strata (urban Appalachia, rural Appalachia, urban non-Appalachia, and rural non-Appalachia) using Kruskal–Wallis and pairwise Wilcoxon tests (Holm adjustment). Rank-based associations between E2SFCA and tract sociodemographics were evaluated using Spearman correlations.

Results

We identified 198 LDCT sites in Tennessee. Urban residents account for 74.10% of those living within ≤20 min, whereas rural residents constitute the majority (63.50%) of the 30–45-min band. Access differed across strata (Kruskal–Wallis χ² = 277.46, p < 2.2 × 10⁻¹⁶): Medians (per 1000) were highest in urban non-Appalachia (0.464) and urban Appalachia (0.430), and lower in rural Appalachia (0.210) and rural non-Appalachia (0.197); all urban–rural contrasts were significant. Regional patterns diverged: West Tennessee showed the largest coverage gap (13.9% zero-access tracts), East Tennessee had the lowest capacity among served tracts (median = 0.339; overall median = 0.293), and Middle Tennessee showed the strongest overall access (overall median = 0.380; 73/647 zero-access; 11.3%).

Conclusions

Rural communities face longer travel times to access LDCT screening sites with more zero-access tracts than urban communities. Our findings support interventions such as adding service points in West Tennessee and expanding capacity in East Tennessee. Strengthening navigation and referral pathways for rural and Appalachian residents is also necessary.

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田纳西州低剂量CT肺癌筛查的地理可及性：社会经济变量、乡村性和阿巴拉契亚地区的差异

肺癌筛查可以早期发现并改善预后，但在获得低剂量计算机断层扫描（LDCT）方面仍然存在地域不平等。我们量化了田纳西州基层LDCT筛查的可及性，并考察了农村和阿巴拉契亚地区的差异。方法：我们编制了具有ldct能力的站点清单，并使用带有三个带状衰减权重的30分钟增强两步浮动集水区（E2SFCA）指数来测量访问情况。使用Kruskal-Wallis和两两Wilcoxon检验（Holm调整）比较了四个阶层（城市阿巴拉契亚、农村阿巴拉契亚、城市非阿巴拉契亚和农村非阿巴拉契亚）的准入情况。利用Spearman相关性评估E2SFCA与地区社会人口统计学之间基于等级的关联。结果：我们在田纳西州确定了198个LDCT点。在≤20分钟区间内，城市居民占74.10%，而在30-45分钟区间内，农村居民占多数（63.50%）。不同阶层间的获取差异（Kruskal-Wallis χ2 = 277.46, p -16）：阿巴拉契亚地区城市（0.464）和阿巴拉契亚地区城市（0.430）的中位数最高，阿巴拉契亚地区农村（0.210）和非阿巴拉契亚地区农村（0.197）的中位数较低；城乡差异均显著。区域格局存在差异：田纳西州西部的覆盖差距最大（13.9%），田纳西州东部的覆盖差距最小（中位数= 0.339，总体中位数= 0.293），田纳西州中部的覆盖差距最大（中位数= 0.380，总体中位数为73/647,11.3%）。结论：与城市社区相比，农村社区前往LDCT筛查点的旅行时间更长，且零通道地区更多。我们的研究结果支持在田纳西州西部增加服务点和扩大田纳西州东部的运力等干预措施。加强农村和阿巴拉契亚地区居民的导航和转诊途径也是必要的。

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来源期刊

Journal of Rural Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

6.10%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Rural Health, a quarterly journal published by the NRHA, offers a variety of original research relevant and important to rural health. Some examples include evaluations, case studies, and analyses related to health status and behavior, as well as to health work force, policy and access issues. Quantitative, qualitative and mixed methods studies are welcome. Highest priority is given to manuscripts that reflect scholarly quality, demonstrate methodological rigor, and emphasize practical implications. The journal also publishes articles with an international rural health perspective, commentaries, book reviews and letters.