Opportunistic Screening for Cardiovascular and Chronic Obstructive Pulmonary Disease Biomarkers and Implications for Downstream Care: A Retrospective Lung Cancer Screening Cohort Study.

Abstract

Objective: Examine the prevalence of low-dose CT (LDCT) biomarkers for cardiovascular disease (coronary artery calcium [CAC]) and chronic obstructive pulmonary disease (emphysema) in asymptomatic lung cancer screening participants and its association with downstream care and social determinants of health (SDoH).

Methods: In this retrospective New York City health-system study, LDCT reports of lung cancer screening enrollees with baseline LDCT (2015-2022) were reviewed for emphysema and CAC. Cardiopulmonary care within 12 months was compared using McNemar's χ² test. Newly received care was compared between participants with and without CAC and emphysema using χ² or Fisher exact tests. Associations with demographic and area-level characteristics were assessed using logistic regression.

Results: Among 2,361 participants (median age, 64; 52% male), emphysema was identified in 76.7% and CAC in 65.1%. Post-LDCT, pulmonary care increased from 24.4% to 45.8% and cardiovascular care from 42.6% to 63.3% (P < .001). Lower ZIP-level median household income (adjusted odds ratio, 1.57 [95% confidence interval, 1.22-2.02]) and greater food insecurity (1.52 [1.20-1.94]) were associated with higher odds of emphysema (both P < .001); no SDoH was associated with CAC. Among those with emphysema, high-poverty ZIP residence (1.74 [1.25-2.42], P < .001) was associated with higher odds of post-LDCT pulmonary care; among those with CAC, lower ZIP-level educational attainment (0.76 [0.60-0.98]; P = .033) was associated with lower odds of post-LDCT cardiovascular care.

Discussion: Emphysema and CAC are highly prevalent and associated with increased post-LDCT cardiopulmonary care; however, future studies are needed to determine whether increased utilization improves clinical outcomes. SDoH were associated with emphysema burden and patterns of post-LDCT care, underscoring the need for equitable care pathways.