Ethan L Bernstein, Brett C Bade, Eric C DeRycke, Kathryn Lerz, Rached Zeghlache, Michal Rose, Jeffrey Kravetz, Melissa M Farmer, Lori Bastian, Kathleen M Akgün, Hilary C Cain
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Eligible patients were enrolled in the screening program and had a baseline Lung-RADS score of 1, 2, or 3. Patients with Lung-Reporting and Data System (RADS) 4 were excluded due to variability in follow-up recommendations. We adjusted for age, race, smoking history, mental/medical comorbidities, and primary care (PC) visits (1-year after first/index CT). Logistic regression modeling was used to determine associations between sex and nonadherence overall and stratified by Lung-RADS 1-2 and Lung-RADS 3. <b><i>Results:</i></b> Among 4,711 Veterans, the overall rate of nonadherence was 34%. Female Veterans were 66% more likely nonadherent to follow-up (odds ratio [OR] = 1.66, confidence interval [CI] = 1.19-2.30) compared with male Veterans. Substance use disorder was associated with greater nonadherence (OR = 1.22, CI = 1.01-1.47). Lower nonadherence was observed among patients with COPD (OR = 0.77, CI = 0.66-0.9) and PC engagement (OR for nonadherence with 5 or more PC visits = 0.78, CI = 0.67-0.91). The associations between sex and nonadherence were similar in models stratified by Lung-RADS groups 1-2, although did not reach significance for the Lung-RADS 3 group. <b><i>Discussion:</i></b> In this cohort, female Veterans were more likely nonadherent. More work is needed to understand the distinct barriers to LCS follow-up among female Veterans. Health care system engagement significantly reduced nonadherence, which may partially explain higher rates of nonadherence among female Veterans who had fewer medical comorbidities.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0000,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Association Between Sex and Lung Cancer Screening Adherence to Follow-Up in a Cohort of Veterans.\",\"authors\":\"Ethan L Bernstein, Brett C Bade, Eric C DeRycke, Kathryn Lerz, Rached Zeghlache, Michal Rose, Jeffrey Kravetz, Melissa M Farmer, Lori Bastian, Kathleen M Akgün, Hilary C Cain\",\"doi\":\"10.1089/jwh.2024.0780\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b><i>Introduction:</i></b> The 2021 update to the United States Preventive Services Task Force guidelines for lung cancer screening (LCS) aims to reduce disparities derived from sex, race/ethnicity, and socioeconomic status. 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Logistic regression modeling was used to determine associations between sex and nonadherence overall and stratified by Lung-RADS 1-2 and Lung-RADS 3. <b><i>Results:</i></b> Among 4,711 Veterans, the overall rate of nonadherence was 34%. Female Veterans were 66% more likely nonadherent to follow-up (odds ratio [OR] = 1.66, confidence interval [CI] = 1.19-2.30) compared with male Veterans. Substance use disorder was associated with greater nonadherence (OR = 1.22, CI = 1.01-1.47). Lower nonadherence was observed among patients with COPD (OR = 0.77, CI = 0.66-0.9) and PC engagement (OR for nonadherence with 5 or more PC visits = 0.78, CI = 0.67-0.91). The associations between sex and nonadherence were similar in models stratified by Lung-RADS groups 1-2, although did not reach significance for the Lung-RADS 3 group. <b><i>Discussion:</i></b> In this cohort, female Veterans were more likely nonadherent. 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引用次数: 0
摘要
2021年更新的美国预防服务工作组肺癌筛查指南(LCS)旨在减少性别、种族/民族和社会经济地位造成的差异。很少有研究涉及女性退伍军人对LCS的依从性。方法:为了评估LCS依从性的性别差异,我们在2013年6月至2020年3月期间对VA康涅狄格州LCS项目进行了回顾性队列研究。我们的主要结局是不依从,定义为没有在指南推荐的间隔加上90天的宽限期内完成胸部CT扫描。符合条件的患者被纳入筛查项目,基线肺- rads评分为1、2或3。由于随访建议的差异,排除了肺部报告和数据系统(RADS) 4的患者。我们调整了年龄、种族、吸烟史、精神/医疗合并症和初级保健(PC)就诊(首次/指数CT后1年)。使用Logistic回归模型确定性别与不依从性之间的关系,并通过Lung-RADS 1-2和Lung-RADS 3分层。结果:在4711名退伍军人中,总体不依从率为34%。女性退伍军人不坚持随访的可能性比男性退伍军人高66%(优势比[OR] = 1.66,可信区间[CI] = 1.19-2.30)。物质使用障碍与更大的依从性相关(OR = 1.22, CI = 1.01-1.47)。COPD患者的不依从性较低(OR = 0.77, CI = 0.66-0.9),参与PC (OR = 0.78, CI = 0.67-0.91)。在Lung-RADS 1-2组分层的模型中,性别和不依从性之间的关联相似,尽管在Lung-RADS 3组中没有达到显著性。讨论:在这个队列中,女性退伍军人更有可能不坚持。需要做更多的工作来了解女性退伍军人LCS随访的明显障碍。医疗保健系统的参与显著减少了不依从性,这可能部分解释了女性退伍军人中较少医疗合并症的不依从率较高。
The Association Between Sex and Lung Cancer Screening Adherence to Follow-Up in a Cohort of Veterans.
Introduction: The 2021 update to the United States Preventive Services Task Force guidelines for lung cancer screening (LCS) aims to reduce disparities derived from sex, race/ethnicity, and socioeconomic status. Few studies have addressed adherence to LCS among female Veterans. Methods: To evaluate differences in adherence to LCS by sex, we conducted a retrospective cohort study within the VA Connecticut LCS Program between June 2013 and March 2020. Our primary outcome was nonadherence, defined as lack of completion of a chest CT scan within the guideline recommended interval plus a 90-day grace period. Eligible patients were enrolled in the screening program and had a baseline Lung-RADS score of 1, 2, or 3. Patients with Lung-Reporting and Data System (RADS) 4 were excluded due to variability in follow-up recommendations. We adjusted for age, race, smoking history, mental/medical comorbidities, and primary care (PC) visits (1-year after first/index CT). Logistic regression modeling was used to determine associations between sex and nonadherence overall and stratified by Lung-RADS 1-2 and Lung-RADS 3. Results: Among 4,711 Veterans, the overall rate of nonadherence was 34%. Female Veterans were 66% more likely nonadherent to follow-up (odds ratio [OR] = 1.66, confidence interval [CI] = 1.19-2.30) compared with male Veterans. Substance use disorder was associated with greater nonadherence (OR = 1.22, CI = 1.01-1.47). Lower nonadherence was observed among patients with COPD (OR = 0.77, CI = 0.66-0.9) and PC engagement (OR for nonadherence with 5 or more PC visits = 0.78, CI = 0.67-0.91). The associations between sex and nonadherence were similar in models stratified by Lung-RADS groups 1-2, although did not reach significance for the Lung-RADS 3 group. Discussion: In this cohort, female Veterans were more likely nonadherent. More work is needed to understand the distinct barriers to LCS follow-up among female Veterans. Health care system engagement significantly reduced nonadherence, which may partially explain higher rates of nonadherence among female Veterans who had fewer medical comorbidities.
期刊介绍:
Journal of Women''s Health is the primary source of information for meeting the challenges of providing optimal health care for women throughout their lifespan. The Journal delivers cutting-edge advancements in diagnostic procedures, therapeutic protocols for the management of diseases, and innovative research in gender-based biology that impacts patient care and treatment.
Journal of Women’s Health coverage includes:
-Internal Medicine
Endocrinology-
Cardiology-
Oncology-
Obstetrics/Gynecology-
Urogynecology-
Psychiatry-
Neurology-
Nutrition-
Sex-Based Biology-
Complementary Medicine-
Sports Medicine-
Surgery-
Medical Education-
Public Policy.