Background/Purpose: Patients with rheumatoid arthritis (RA) are at elevated risk for lung cancer. Lung cancer screening (LCS) with low-dose computed tomography (LDCT) is recommended for high-risk individuals, but uptake among patients with RA remains unclear. Purpose: To assess LDCT screening rates and factors associated with LCS uptake among eligible patients with RA using a large, real-world U.S. claims database.

Methods: We conducted a retrospective cohort study using the 2006-2023 IQVIA PharMetrics® Plus claims database. Adults aged 50–77 with ≥2 RA diagnoses (ICD-9/10) at least 60 days apart between 2014 and 2023 were included if they had continuous insurance enrollment and a history of smoking (used as a proxy for LCS eligibility due to the lack of pack-year and quit-date data), based on diagnosis and procedure codes. Patients with prior lung cancer, advanced malignancy, or severe respiratory conditions were excluded to reflect a screen-eligible population. LDCT screening was identified using HCPCS and CPT codes. We described patient characteristics and used multivariable logistic regression to identify predictors of LCS uptake.

Results: From 374,952 RA patients, only 15,341 met inclusion criteria. Among them, 6.5% (n=997) received LDCT screening, with a median time from RA diagnosis to screening of 452 days (IQR: 218–894). Screening rates increased from 3.6% in 2015 (when Medicare began covering LDCT on February 5, 2015) to a peak of 13.2% in 2020. Uptake varied by sex (7.4% in males vs. 6.1% in females), age (highest in ages 62 to 69), and region (8.5% in Midwest vs. 2.8% in West). Multivariate analysis showed statistically significant higher (ρ< 0.05) odds of screening in more recent diagnosis years, males (AdjOR 1.25), those aged 55–69 (AdjOR 1.92), and those with COPD (AdjOR 2.79). A higher comorbidity burden was inversely associated with screening (AdjOR 0.78). Patients receiving conventional synthetic DMARDs or combination therapy had higher screening rates than those who did not receive treatment during the study period (AdjOR 1.29 and AdjOR 1.56, respectively).

Conclusion: LDCT screening rates among RA patients with a smoking history remain low, with significant variation by sex, age, region, and clinical characteristics. These findings highlight gaps in adherence to LCS guidelines and suggest opportunities for targeted interventions in this high-risk population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/lung-cancer-screening-with-rheumatoid-arthritis-a-retrospective-claims-analysis/