Factors Associated with Uptake of Lung Cancer Screening Among High-Risk Individuals: A Systematic Review and Meta-Analysis

Abstract

Low-dose computed tomography (LDCT) screening reduces lung cancer mortality through early detection. However, lung cancer screening uptake among high-risk groups remains low and varies by setting. This study aims to assess the factors associated with LDCT screening uptake among high-risk individuals. We searched Medline (Ovid), Embase (Ovid), and Scopus for observational studies and randomized controlled trials of high-risk individuals published up to May 31, 2026. Random-effects models estimated pooled odds ratios (ORs) for LDCT uptake among high-risk individuals, with subgroup, sensitivity, publication bias, and risk of bias assessments. Of 9117 publications, 61 met the inclusion criteria. Pooled overall LDCT uptake was 39.5% (95% CI: 33.2%–46.1%), with higher uptake in the UK (91.3%) than China (39.8%) and the US (33.2%). Screening uptake was lower among current smokers (OR=0.88, 95% CI: 0.79–0.97), those living in rural areas (OR=0.89, 95% CI: 0.82–0.96), and the least affluent (OR=0.85, 95% CI: 0.74–0.98), while it was higher among those with health insurance group (OR=2.96, 95% CI: 2.35–3.74), those with COPD (OR=1.85, 95% CI: 1.42–2.41), and those with a family history of lung cancer (OR=1.67, 95% CI: 1.48–1.88). Sensitivity analyses indicated robustness, with an overall low-to-moderate risk of bias. Smoking, living in rural areas, and deprivation were associated with lower uptake, while health insurance, COPD, and family history of lung cancer were associated with higher uptake. High study heterogeneity warrants cautious interpretation. Lung cancer screening campaigns should target smokers, rural residents, and less affluent individuals to reduce disparities. Future research should include low- and middle-income countries.