Abstract 4971: Predicting lung cancer screening adherence among underserved and minoritized communities using social determinants and neighborhood factors
Authors: Kun-Han Lu, Yi Xiao, Aamna Akhtar, Jazma Tapia, Calvin Tribby, Jay Yang, Marta Jankowska, Chi Wah Wong, Loretta Erhunmwunsee
Journal: Cancer Research (2025)

Abstract Purpose: Lung cancer screening (LCS) lowers cancer mortality if individuals adhere to annual scans. Minoritized communities have significantly lower adherence to LCS than non-Hispanic whites. The influence of social determinants of health (SDOH) on these disparate adherence rates are rarely evaluated. The aim of this study is to develop a machine learning (ML) model that integrates individual and neighborhood level SDOH to predict which minoritized individuals are at risk of LCS non-adherence. Methods: A total of 168 participants with high-risk smoking histories who underwent their first low dose computed tomography (LDCT) between 2017 and 2021 were enrolled. Surveys on SDOH and perceived discrimination were completed. Participants’ addresses were joined to neighborhood level SDOH data from various publicly available sources. These indices captured neighborhood socioeconomic status and segregation. Adherence rates were calculated by assessing electronic medical records to determine if participants had a second LDCT within 15 months. Participants were temporally split into training (N=125) and testing (N=43) sets with a cut-off date of June 30, 2021. A gradient boosting classifier, XGBoost, was trained to predict LCS non-adherence, incorporating variables such as sociodemographic status, perceived discrimination, previous screenings, smoking status, and geospatial indices. The SHapley Additive exPlanations (SHAP) method was used to determine the relative importance of each feature in the model’s predictions. Results: The participants represented a diverse group: Asian (26%), Black/African American (32%), and Hispanic/Latino (32%). The LCS non-adherence rates were 66% in the training set and 63% in the testing set. The XGBoost classifier achieved an Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.79 and an Area Under the Precision-Recall Curve (AUPRC) of 0.90, outperforming a simple logistic regression model (AUROC=0.63 and AUPRC=0.79). The XGBoost classifier’s performance metrics were Accuracy=0.77, Recall=0.85, Specificity=0.62, Positive Predictive Value=0.79, and Negative Predictive Value=0.71. The SHAP analysis indicated that participants with no prior history of colorectal cancer screening, who lived in areas with lower quality school systems, and with a higher percentage of individuals below the poverty line, were at a higher risk of non-adherence to LCS. Conclusions: LCS reduces lung cancer survival, but LCS adherence is significantly lower in minoritized groups. Our ML model strongly predicted LCS non-adherence based on SDOH and geospatial factors. Specific neighborhood level SDOHs predicted LCS non-adherence more strongly than individual level factors. These findings support interventions that address both individual and neighborhood-level barriers to increase LCS adherence. Citation Format: Kun-Han Lu, Yi Xiao, Aamna Akhtar, Jazma Tapia, Calvin Tribby, Jay Yang, Marta Jankowska, Chi Wah Wong, Loretta Erhunmwunsee. Predicting lung cancer screening adherence among underserved and minoritized communities using social determinants and neighborhood factors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4971.