ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2026
Geographic Access to Low-Dose CT Lung Cancer Screening in Tennessee: Disparities by Socioeconomic Variables, Rurality, and Appalachian Status.
Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionLung cancer screening enables earlier detection and improved outcomes, yet geographic inequities persist in access to low-dose computed tomography (LDCT). We quantified tract-level access to LDCT screening in Tennessee and examined disparities by rurality and Appalachian status.
methodsWe compiled an inventory of LDCT-capable sites and measured access using a 30-min enhanced two-step floating catchment area (E2SFCA) index with three banded decay weights. Access was compared across four strata (urban Appalachia, rural Appalachia, urban non-Appalachia, and rural non-Appalachia) using Kruskal-Wallis and pairwise Wilcoxon tests (Holm adjustment). Rank-based associations between E2SFCA and tract sociodemographics were evaluated using Spearman correlations.
resultsWe identified 198 LDCT sites in Tennessee. Urban residents account for 74.10% of those living within ≤20 min, whereas rural residents constitute the majority (63.50%) of the 30-45-min band. Access differed across strata (Kruskal-Wallis χ
conclusionsRural communities face longer travel times to access LDCT screening sites with more zero-access tracts than urban communities. Our findings support interventions such as adding service points in West Tennessee and expanding capacity in East Tennessee. Strengthening navigation and referral pathways for rural and Appalachian residents is also necessary.
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