Measuring health-related social risks in a lung cancer screening cohort

OBJECTIVE: 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. 

METHODS: 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. 

RESULTS: 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. 

DISCUSSION: 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.