Citations

Abstract Rationale Rural populations in the US experience a higher lung cancer burden compared to urban residents, potentially due to differences in risk factors and access to preventative care and early detection. We sought to characterize tobacco use, smoking cessation, and lung cancer screening patterns by rurality to identify modifiable gaps in the lung cancer care continuum. Methods We analyzed data from current and former smoking adults in the Southern Community Cohort Study, a large prospective cohort recruited from community health centers across 12 southeastern states. Participants aged 65-80 years with at least 9 months of Medicare Part A/B and less than 3 months of Part C coverage between 2014 and 2020 were included. Data were linked with the National Death Index and Medicare claims for outcome ascertainment. Rurality was defined using Rural-Urban Commuting Area (RUCA) codes. We compared demographic characteristics, smoking patterns, use of smoking cessation interventions, and receipt of low-dose computed tomography (LDCT) screening between rural and urban participants over time. Results Among 10,114 adults included (56% urban; 46% rural), 54% were female, 55% identified as Black/African American, about a third reported less than a high school education, and 45% lived in areas in the highest quartile of deprivation. Urban residents were of similar age (66 vs 67 years), and more likely to currently smoke (42% vs 35%), but had fewer baseline smoking pack-years (27 vs 30 pack-years) than rural residents. Approximately 2% died of lung cancer during follow-up. Using the USPSTF 2013 lung cancer screening criteria, 27% of urban and 26% of rural residents were eligible. This increased unevenly to 38% urban and 35% rural under the USPSTF 2021 criteria. LDCT uptake was low, increasing from 0% in 2014 to 6% in 2020 among screening-eligible participants. Use of cessation interventions was similarly low. Among current smoking participants, 7% received smoking cessation counseling, and 3% had a varenicline prescription. These patterns remained relatively stable over time, with no significant rural-urban differences in LDCT and cessation intervention use. Conclusion Despite modest differences in smoking prevalence and screening eligibility, we found comparable lung cancer mortality and similarly low utilization of LDCT and cessation interventions among rural and urban residents. Our findings suggest that, among people in lower socioeconomic groups, shared socioeconomic constraints may extend beyond the rural-urban divide. Further research is needed to understand how social determinants of health may be addressed to improve lung cancer outcomes across the screening continuum. This abstract is funded by: NIH

AbstractThis first Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE‐1) from the Society for Academic Emergency Medicine is on the topic: Recurrent, Low‐risk Chest Pain in the Emergency Department. The multidisciplinary guideline panel used The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding eight priority questions for adult patients with recurrent, low‐risk chest pain and have derived the following evidence based recommendations: (1) for those >3 h chest pain duration we suggest a single, high‐sensitivity troponin below a validated threshold to reasonably exclude acute coronary syndrome (ACS) within 30 days; (2) for those with a normal stress test within the previous 12 months, we do not recommend repeat routine stress testing as a means to decrease rates of major adverse cardiac events at 30 days; (3) insufficient evidence to recommend hospitalization (either standard inpatient admission or observation stay) versus discharge as a strategy to mitigate major adverse cardiac events within 30 days; (4) for those with non‐obstructive (<50% stenosis) coronary artery disease (CAD) on prior angiography within 5 years, we suggest referral for expedited outpatient testing as warranted rather than admission for inpatient evaluation; (5) for those with no occlusive CAD (0% stenosis) on prior angiography within 5 years, we recommend referral for expedited outpatient testing as warranted rather than admission for inpatient evaluation; (6) for those with a prior coronary computed tomographic angiography within the past 2 years with no coronary stenosis, we suggest no further diagnostic testing other than a single, normal high‐sensitivity troponin below a validated threshold to exclude ACS within that 2 year time frame; (7) we suggest the use of depression and anxiety screening tools as these might have an effect on healthcare use and return emergency department (ED) visits; and (8) we suggest referral for anxiety or depression management, as this might have an impact on healthcare use and return ED visits.