Utilization of Lung Cancer Screening in the Medicare Fee-for-Service Population.
A number of organizations, including the U.S. Preventative Services Task Force (USPSTF), recommend lung cancer screening (LCS) with low dose computed tomography (LDCT) for high-risk current and former smokers. In 2015, Medicare issued a decision to cover LCS as a preventative health benefit, however utilization in the Medicare population has not been thoroughly examined.Our objective was to evaluate the early utilization of LCS in the Medicare fee-for-service (FFS) population and determine the relationship(s) among beneficiary sociodemographic characteristics, geographical location, and utilization.and Methods.This cross-sectional observational study utilized 100% Medicare FFS claims files for Medicare beneficiaries receiving LCS between January 1, 2016 – December 31, 2016. We estimated the LCS eligible Medicare population using population and smoking data from the U.S. Census Bureau and Centers for Disease Control and Prevention (CDC). We assessed variation in LCS rates by beneficiary characteristics and geography using univariate and multivariate regression, the latter also including how interactions between geographical location and race/ethnicity influence screening.A total of 103,892 Medicare FFS beneficiaries received LCS in 2016, comprising 4.1% (95% CI 3.9 – 4.3%) of the estimated LCS eligible Medicare population. Accounting for the interactions between race/ethnicity and U.S. region, non-White (Black, Hispanic) beneficiaries in all U.S. regions were screened with less frequency than White beneficiaries (p<0.001). Screening rates in the Northeast were significantly higher than other regions (adjusted rate ratio (95% CI) of Northeast relative to South: 1.83 (1.36-2.46)).The early adoption of LCS amongst Medicare beneficiaries was low. Our results suggest geographic and racial disparities in screening utilization, with populations in the South and those of non-White race/ethnicity being screened with less frequency. Further work is needed to improve LCS uptake and ensure consistent use by all at-risk populations.