Table 3.

Studies describing rural/geographic disparities in LDCT screening

Author	Study type	Data source	Years studied	Research question/objective	Main finding(s)
Eberth et al. (13)	Retrospective, observational	Lung Cancer Alliance Screening Centers of Excellence	2017	To determine the extent of geographic variation in LDCT facility distribution in the United States and to identify regions for program expansion.	There was an 8.5-fold increase in the number of LDCT screening facilities in the United States between 2014 and 2017. 15% of eligible patients do not have access to a screening center within 30 miles nationally and screening center availability remains limited in rural states.
Martin et al. (31)	Retrospective, observational	Virginia Central Cancer Registry; BRFSS; ACR accredited facility database	2015	To evaluate the capacity of lung cancer screening for high-risk individuals in the state of Virginia	Despite higher smoking and lung cancer mortality rates, rural counties had only 5% of available LDCT screening centers in the state of Virginia.
Eberth et al. (32)	Retrospective, observational	Lung Cancer Alliance Screening Centers of Excellence	2014	What is the geographic distribution of accredited LDCT screening facilities in the United States in 2014?	The majority of LDCT screening facilities in 2014 were concentrated in Northeast and East North Central states. Several states with high lung cancer incidence and mortality rates had few or no available LDCT screening centers.
Kale et al. (33)	Retrospective, observational	Lung Cancer Screening Registry; BRFSS; SEER	2016–2018	To compare LDCT facility geographic access with lung cancer incidence, mortality, and socioeconomic environment	Southeastern states had the lowest number of LDCT screening facilities, the slowest rate of new facility development between 2016 and 2018, and the highest smoking and lung cancer burdens.
Tailor et al. (34)	Cross-sectional	BRFSS; Google Maps; ACR accredited facility database	2016	To determine the nationwide distribution current smokers by census tract and the estimated driving distance to the nearest accredited LDCT screening facility	81% of smokers live within 15-miles of an accredited LDCT screening facility. Smokers living in rural areas have significantly less access to LDCT screening facilities.
Tailor et al. (35)	Cross-sectional	BRFSS; Google Maps; ACR accredited facility database	2016	To evaluate the association between geographic access to accredited LDCT screening facilities and census tract socioeconomic characteristics	Census tract population density was the greatest relative determinant of distance to LDCT screening facility. Census tracts with higher proportions of uninsured/Medicaid insured individuals and individuals with less formal education had significantly greater travel distances to LDCT screening centers.

LDCT, low-dose computed tomography; BRFSS, Behavioral Risk Factor Surveillance System Survey; SEER, Surveillance, Epidemiology, and End Results; ACR, American College of Radiology.