State law at the intersection of lung cancer screening guidelines and social determinants of health

Background

Lung cancer is a significant public health issue and social determinants of health (SDOH) may contribute to lung cancer disparities. Given the racial/ethnic disparities in meeting eligibility and referral for lung cancer screening and the recent introduction of SDOH ICD-codes (Z-codes) into the electronic health record, state-level policies that address Z-codes may support the expansion of lung cancer screening criteria to consider SDOH.

Methods

State statutes and administrative regulations were collected for all 50 states and DC using keyword searches in primary legal databases. Relevant content included state laws concerning lung cancer and/or SDOH screening with Z-codes, available as of October 31, 2024.

Results

Twenty states addressed lung cancer in their laws, mainly focused on awareness. Nine states had laws to create lung cancer task forces or programs, five of which focused on a specific population. In state laws that addressed Z-codes, eight states captured SDOH and/or the use of Z-codes within the healthcare setting. Six states had laws that mentioned the use of Z-codes alone would not be sufficient to provide behavioral/mental health services.

Conclusion

Although the introduction of SDOH risk factors into lung cancer screening guidelines may more effectively identify high-risk individuals, only handful of states have developed lung cancer specific programs, and a smaller proportion addressed populations disproportionately affected by lung cancer. Z-codes could help indicate when a person who is not eligible for LDCT under current guidelines, should still be referred based on an enhanced set of guidelines that factor in social and neighborhood factors that may increase the risk of developing lung cancer.

Policy summary

State laws have an opportunity to promote enhanced lung cancer screening guidelines that better incorporate SDOH based on population needs. State laws could also support the collection and capture of SDOH-related Z-codes in medical records.