LOWER socioeconomic status, as measured in the UK by the Index of Multiple Deprivation (IMD), is associated with a higher risk of numerous health issues, such as lung cancer and smoking-related disease mortality, yet reduced recruitment for cancer screening. According to research, low-dose CT is more beneficial for lower socioeconomic groups, in terms of reducing the risk of mortality from COPD and emphysema, than for higher socioeconomic groups.
The researchers explored the impact of low-dose CT screening on the risk of smoking-related disease mortality across different socioeconomic groups. The UKLS low-dose CT (LDCT) screening trial for lung cancer early demonstrated that CT screening reduces lung cancer mortality in high-risk populations. Following this, 4055 participants identified as having the highest risk of lung cancer were grouped into IMD quintiles, with the deprived group defined as the lower two quintiles (Q1-2) and the less deprived as Q3-5. The impact of socioeconomic status on a variety of aspects was examined, including initial recruitment, selection for screening, lung cancer detection, and mortality from smoking-related diseases.
The benefit of LDCT for lung cancer survival was similar across socioeconomic groups, with a hazard ratio of 1.89 (95% CI: 1.16–3.08) for lower IMD quintiles and 1.87 (95% CI: 1.07–3.26) for upper quintiles. However, LDCT was associated with fewer deaths due to COPD and emphysema in more deprived quintiles, -34% for Q1-1 but no reduction for Q3-5 (+4%). Furthermore, the time to death due to COPD or emphysema was shorter in the more deprived quintiles without LDCT.
Health disparity is an ongoing challenge throughout healthcare, but this study highlights the disparity in lung cancer screening across socioeconomic groups. Health inequity may be reduced using risk profiling to select those for screening where the need is greatest, for example, in deprived populations and areas with higher smoking rates.
Reference
Davies P.A. M et al. Impact of single round of low dose CT lung cancer screening on cause of mortality in different socio-economic groups: a post-hoc analysis of long-term follow-up of the UKLS trial. The Lancet Regional Health–Europe. 2024;42.
