Measuring Health-Related Social Risks in a Lung Cancer Screening Cohort.

Abstract

To evaluate the feasibility and limitations of measuring health-related social risks (HRSRs) affecting individuals in a lung cancer screening (LCS) cohort from multiple data sources. A single-institution study analyzed data from 227 participants in a pragmatic LCS trial in west and southwest Philadelphia. HRSRs were assessed using three approaches: (1) electronic health records (EHRs) capturing individual-level social risks (eg, financial strain, housing stability); (2) neighborhood-level analysis using a modified Yost index to determine socio-economic status; and (3) semistructured interviews with 15 participants to identify barriers and facilitators to LCS adherence. EHR data revealed financial strain and housing instability as the most documented HRSRs, although missing data ranged from 64% to 69%. Neighborhood-level analysis showed participants had lower socio-economic status compared with their broader communities, with Yost index scores of 1.28 (west Philadelphia) and 1.20 (southwest Philadelphia). Interviews highlighted limited knowledge of LCS (87% unaware before clinician referral), reliance on public or supplemental transportation, and overall trust in health care providers. Transportation was not a significant reported barrier to LCS adherence. This study demonstrates the promise and limitations of EHR data, neighborhood-level data, and patient interviews to assess HRSRs. Although EHRs provided limited and inconsistent data, interviews captured granular individual experiences, and neighborhood-level analysis contextualized socio-economic influences. Comprehensive and consistent data collection across multiple sources is critical in understanding HRSRs experienced by individuals.