PCN151 The Geographical Association with LUNG Cancer Incidents, Mortality, and Accessibility of LUNG Cancer Screening in RURAL Appalachia

Lung cancer accounts for about one-fourth of cancer deaths in the US. Appalachian states are disproportionally affected by lung cancer incidence and mortality. Lung cancer screening using low dose computed tomography (LDCT) is recommended for high-risk people. However, there is little information available on access to LDCT screening centers, especially in rural Appalachia. The purpose of this study was to determine the spatial association of lung cancer deaths in Appalachian states. This study used data from the Centers for Disease Control and Prevention, US Census Bureau, US Department of Agriculture, and Surveillance, Epidemiology, and End Result Program. Hot spot and mean center analysis were conducted to plot the distribution of the LDCT centers in the six Appalachian states: Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia. The spatial regression analysis was performed using CARBayes Package in R-studio to assess the association of rurality, available Computed tomographic arterial portography (CTAP) count, % living below the poverty level, and % adult smokers with the age-adjusted lung cancer incidence and age-adjusted death rates from lung cancer. The average lung cancer incidence and mortality rates in the Appalachian states were 78.34 (SD=19.51) and 57.92 (SD=15.64), respectively. The average lung cancer incidence rates in rural areas were 82.92 (SD=20.15) and in urban areas were 71.94 (SD=16.63). The LDCT screening centers were mostly located in densely populated urban areas where an inverse association with lung cancer mortality rates was found. The lack of awareness and inaccessibility to early detection in rural areas were associated with the high rate of lung cancer incidents and death. The study gave a clear message to the health care providers to increase the public health awareness about smoking and also equal distribution of screening centers is a must.