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We used a regression discontinuity design to measure the impact of nearly universal Medicare coverage at age 65 on first\u2010time receipt of screening (primary outcome) and the proportion of screened individuals with detected lung cancer (secondary outcome).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>First\u2010time screens at age 60\u201369 in the American College of Radiology's Lung Cancer Screening Registry data, 2015\u20132020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>Nearly\u2010universal access to Medicare at 65 increased first\u2010time lung cancer screening by 5450 per year (CI 4911\u20135990), a 41% increase compared to age 64. Eighty\u2010nine percent of additional screens were among people who met screening eligibility criteria. Increases at age 65 were larger in rural areas than nonrural areas (52% vs. 39%) and were similar for men and women (41% and 42%). There was no statistically significant change in the proportion of screened individuals with lung cancer detected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>First\u2010time receipt of lung cancer screening increases at age 65, particularly among people in rural areas. Cancer detection rates did not worsen, suggesting screening remained well targeted as it increased.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.14638","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T22:28:21Z","timestamp":1746743301000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Delaying Screening Until Covered? Changes in Lung Cancer Screening at the Age of Nearly\u2010Universal Medicare Insurance"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3355-3720","authenticated-orcid":false,"given":"Marcelo C.","family":"Perraillon","sequence":"first","affiliation":[{"name":"Department of Health, Systems, Management and Policy University of Colorado Anschutz Medical Campus  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Warren","sequence":"additional","affiliation":[{"name":"University of Colorado Anschutz Medical Campus  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenka","family":"Goldman","sequence":"additional","affiliation":[{"name":"American College of Radiology  Reston Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie L.","family":"Studts","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Department of Medicine University of Colorado Anschutz Medical Campus  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7567-936X","authenticated-orcid":false,"given":"Rebecca M.","family":"Myerson","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences University of Wisconsin School of Medicine and Public Health  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,8]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.0377"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1102873"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.7326\/m13\u20102771"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djaa170"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.07.030"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2016.9016"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cllc.2019.09.002"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2024.1655"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.3190"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jnma.2021.05.012"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21811"},{"key":"e_1_2_9_13_1","unstructured":"Centers for Medicare and Medicaid \u201cScreening for Lung Cancer With Low Dose Computed Tomography (LDCT) \u201daccessed November 25 2023 https:\/\/www.cms.gov\/medicare\u2010coverage\u2010database\/view\/ncacal\u2010decision\u2010memo.aspx?proposed=N&ncaid=304."},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201703\u2010204PS"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2018180212"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2020.03.66"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2020.03.001"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1312547"},{"key":"e_1_2_9_19_1","unstructured":"MDSave \u201cHow Much Does a Low Dose CT Lung Screening Cost?\u201dTendo Marketplace accessed March 26 2025 https:\/\/www.mdsave.com\/procedures\/low\u2010dose\u2010ct\u2010lung\u2010screening\/d785f5cf#:~:text=How%20Much%20Does%20a%20Low Dose%20CT%20Lung%20Screening%20Cost."},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2012.0023"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2017.0610"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/mlr.0000000000001903"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/pam.22199"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2014.06.013"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201907\u2010556CME"},{"key":"e_1_2_9_26_1","unstructured":"M. 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