• Minal S Kale, Juan Wisnivesky, Emanuela Taioli, and Bian Liu.
• Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
• Chest. 2019 May 1; 155 (5): 900907900-907.

BackgroundLow adoption of lung cancer screening is potentially caused by inadequate access to a comprehensive lung cancer screening registry (LCSR), currently a requirement for reimbursement by the Centers for Medicare and Medicaid Services. However, variations in LCSR facilities have not been extensively studied.MethodsWe applied a hierarchical clustering method to a comprehensive database integrating state-level LCSR facility density, defined as the number of facilities per 100,000 at-risk persons, lung cancer outcomes including mortality and stage-specific incidence, and socioeconomic and behavioral factors.ResultsWe found three distinct clusters of LCSR facilities roughly corresponding to the northern (cluster 1), southeastern (cluster 2), and southwestern (cluster 3) states. The southeastern states had the lowest total number of facilities (67 ± 44 in cluster 2, 74 ± 69 in cluster 1, 80 ± 100 in cluster 3), the slowest increase in facilities (23 ± 20 in cluster 2, 26 ± 28 in cluster 1, 27 ± 32 in cluster 3) between 2016 and 2018, and the highest lung cancer burden and current smokers. They ranked second in terms of facility density (2.9 ± 1.0 in cluster 3, 3.8 ± 1.3 in cluster 2, 6.3 ± 2.8 in cluster 1) and increase in facility density (1.1 ± 0.3 in cluster 3, 1.3 ± 0.7 in cluster 2, 2.5 ± 2.5 in cluster 1).ConclusionsWe found substantial state-level variability in LCSR facilities tied to lung cancer burden, socioeconomic characteristics, and behavioral characteristics. Given the known risk factors of lung cancer, correcting a suboptimal distribution of screening programs will likely lead to improved lung cancer outcomes.Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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