Abstract
BACKGROUND: Lung cancer remains a leading cause of cancer-related mortality in urban China, underscoring the urgency of effective screening programs. Despite the proven efficacy of low-dose computed tomography (LDCT) in reducing lung cancer mortality, participation rates among high-risk populations remain suboptimal. This study aspired to determine factors influencing LDCT screening adherence among high-risk individuals in Nanjing, China, as part of the China Urban Cancer Screening Project (CanSPUC). METHODS: A cross-sectional study was conducted from 2019 to 2023, involving 52,910 participants aged 45-74 years. High-risk individuals were identified using a modified Harvard Risk Index adjusted for Chinese demographics. Socio-demographic and clinical data were collected via questionnaires and LDCT reports, with missing values imputed via random forest models. Logistic regression was used to determine the factors associated with LDCT screening adherence. RESULTS: Among 16,020 high-risk participants, only 45.4% (7,280/16,020) underwent LDCT. Key factors influencing participation included gender (OR = 1.36, 95% CI:1.24-1.49, p < 0.001), education level (OR = 1.18, 95%CI:1.10-1.26, p < 0.001), occupational exposure (OR = 1.20, 95%CI: 1.11-1.29, p < 0.001), current smoking (OR = 1.26, 95%CI:1.13-1.40, p < 0.001), family cancer history (OR = 1.37, 95%CI:1.28-1.46, p < 0.001), and tuberculosis history (OR = 0.84, 95%CI:0.72-0.97, p = 0.022). LDCT detected lung cancer in 0.47% (34/7,280), with semi-positive nodules observed in 43.16% (3,142/7,280) of screened individuals. CONCLUSIONS: Despite effective risk stratification, participation in LDCT screening remains low in urban China. Targeted interventions to solve gender disparities, health literacy gaps, and risk communication may be very important to improve the intake rate. Perhaps future efforts should give priority to community-based education, enhanced accessibility, and tailored protocols to reduce lung cancer mortality in high-risk populations.