Lung cancer is the leading cause of cancer death in the United States and contributes to more cancer deaths than breast, colorectal, and prostate cancer combined [1]. Efforts to improve lung cancer-related mortality focus on addressing risk factors (e.g. smoking cessation) and detecting lung cancer earlier through screening. The National Lung Screening Trial demonstrated a 20% relative reduction in lung cancer-related mortality in high-risk patients who underwent screening with annual low-dose computed tomography (LDCT) compared to chest radiograph [2]. In December of 2013, the United States Preventive Services Task Force (USPSTF) published a statement recommending annual lung cancer screening with LDCT in high-risk patients, specifically adults aged 55–80 with a 30 pack-year smoking history who currently smoke or quit smoking within the last 15 years [3]. More recently, the USPSTF expanded qualifying criteria for annual lung cancer screening to adults aged 50–80 with at least a 20 pack-year smoking history who currently smoke or quit within the last 15 years [4]. Despite these recommendations and evidence that screening in high-risk populations can decrease lung cancer mortality, screening remains low at <5% of eligible adults nationally [5]. Older age, female sex, and current smoking status are associated with an increased likelihood of receiving lung cancer screening, while patients identified as Black or socioeconomically disadvantaged are less likely to obtain lung cancer screening [6].

Hospitalization can be an opportunity to engage patients in lung cancer prevention and screening. During hospitalization, a clinician-patient relationship is established and can be an opportune moment to engage patients in efforts to improve their health [7], [8]. Shared decision-making discussions about lung cancer screening during hospitalization show promise in improving screening rates in underserved patients [9]. Historically, lung cancer screening has been deferred to primary care with the thought that decisions on cancer screening and the follow-up of test results benefit from the longitudinal relationship primary care clinicians ideally achieve with patients. However, current lung cancer screening rates remain unacceptably low, and this strategy may exacerbate disparities in lung cancer screening for disadvantaged patients who may have limited access to primary care [10].

Before implementing a hospital-based lung cancer screening referral program that includes shared-decision making and orders for lung cancer screening, we examined the association of hospitalization with completion of LDCT lung cancer screening in a university-based primary care clinic in the Southeastern US. We hypothesized that hospitalization would not be significantly associated with obtaining a LDCT for lung cancer screening, and thus hospitalization may be an underutilized opportunity to improve rates of lung cancer screening in high-risk patients.