{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T09:02:33Z","timestamp":1793091753447,"version":"4.5.0"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Screening with low-dose computed tomography (CT) has been shown to reduce mortality from lung cancer in randomized clinical trials in which the rate of adherence to follow-up recommendations was over 90%; however, adherence to Lung Computed Tomography Screening Reporting &amp;amp; Data System (Lung-RADS) recommendations has been low in practice. Identifying patients who are at risk of being nonadherent to screening recommendations may enable personalized outreach to improve overall screening adherence.<\/jats:p><\/jats:sec>Objective<\/jats:title>To identify factors associated with patient nonadherence to Lung-RADS recommendations across multiple screening time points.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study was conducted at a single US academic medical center across 10 geographically distributed sites where lung cancer screening is offered. The study enrolled individuals who underwent low-dose CT screening for lung cancer between July 31, 2013, and November 30, 2021.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Low-dose CT screening for lung cancer.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The main outcome was nonadherence to follow-up recommendations for lung cancer screening, defined as failing to complete a recommended or more invasive follow-up examination (ie, diagnostic dose CT, positron emission tomography\u2013CT, or tissue sampling vs low-dose CT) within 15 months (Lung-RADS score, 1 or 2), 9 months (Lung-RADS score, 3), 5 months (Lung-RADS score, 4A), or 3 months (Lung-RADS score, 4B\/X). Multivariable logistic regression was used to identify factors associated with patient nonadherence to baseline Lung-RADS recommendations. A generalized estimating equations model was used to assess whether the pattern of longitudinal Lung-RADS scores was associated with patient nonadherence over time.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 1979 included patients, 1111 (56.1%) were aged 65 years or older at baseline screening (mean [SD] age, 65.3 [6.6] years), and 1176 (59.4%) were male. The odds of being nonadherent were lower among patients with a baseline Lung-RADS score of 1 or 2 vs 3 (adjusted odds ratio [AOR], 0.35; 95% CI, 0.25-0.50), 4A (AOR, 0.21; 95% CI, 0.13-0.33), or 4B\/X, (AOR, 0.10; 95% CI, 0.05-0.19); with a postgraduate vs college degree (AOR, 0.70; 95% CI, 0.53-0.92); with a family history of lung cancer vs no family history (AOR, 0.74; 95% CI, 0.59-0.93); with a high age-adjusted Charlson Comorbidity Index score (\u22654) vs a low score (0 or 1) (AOR, 0.67; 95% CI, 0.46-0.98); in the high vs low income category (AOR, 0.79; 95% CI, 0.65-0.98); and referred by physicians from pulmonary or thoracic-related departments vs another department (AOR, 0.56; 95% CI, 0.44-0.73). Among 830 eligible patients who had completed at least 2 screening examinations, the adjusted odds of being nonadherent to Lung-RADS recommendations at the following screening were increased in patients with consecutive Lung-RADS scores of 1 to 2 (AOR, 1.38; 95% CI, 1.12-1.69).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this retrospective cohort study, patients with consecutive negative lung cancer screening results were more likely to be nonadherent with follow-up recommendations. These individuals are potential candidates for tailored outreach to improve adherence to recommended annual lung cancer screening.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.15250","type":"journal-article","created":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T15:33:48Z","timestamp":1685028828000},"page":"e2315250","source":"Crossref","is-referenced-by-count":17,"title":["Factors Associated With Nonadherence to Lung Cancer Screening Across Multiple Screening Time Points"],"prefix":"10.1001","volume":"6","author":[{"given":"Yannan","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Bioengineering, University of California, Los Angeles"},{"name":"Medical & Imaging Informatics, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Jung","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Medicine, 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