How do health literacy and chronic disease influence the diagnostic evaluation of patients with lung cancer symptoms?
DOI:
https://doi.org/10.2340/1651-226X.2025.44113Keywords:
Lung neoplasms, diagnosis, general practice, diagnostic imaging, social inequityAbstract
Background and purpose: Smoking status, health literacy challenges and chronic diseases may influence the diagnostic evaluation of patients presenting with lung cancer symptoms (LCSs) in general practice. This study aimed to (1) analyse associations between smoking status, health literacy, chronic disease and having completed diagnostic imaging amongst patients with LCSs in Danish general practice and (2) investigate how these factors interact in relation to the completion of diagnostic imaging, by examining effect modification and causal mediation.
Patient/material and methods: In 2022, a random sample of 100,000 individuals aged ≥ 20 years from the Danish population was invited to participate in a survey about symptoms and healthcare seeking. This study included individuals aged ≥ 40 years who reported general practitioner (GP) contact with LCSs. Questionnaire data included health literacy, chronic disease and smoking status. Register data included socioeconomics, prescription drugs and diagnostic imaging. Descriptive statistics, multivariable logistic regression and causal mediation models were applied.
Results: Of the 2,252 patients who had contacted their GP with LCSs, 22% had completed diagnostic imaging. Formerly smoking increased odds of diagnostic imaging compared to never smoking, whereas current smoking had no influence. No associations or mediations were demonstrated between health literacy, chronic disease and diagnostic imaging. Effect modification was implied by varying impact of health literacy on diagnostic imaging depending on smoking status, yet the results were limited by power.
Interpretation: Initiatives targeting awareness of the risk of overlooking cancer symptoms amongst high-risk patients presenting in general practice may improve the chance of timely diagnosis of lung cancer.
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Copyright (c) 2025 Lisa Maria Sele Sætre, Kirubakaran Balasubramaniam, Sonja Wehberg, Christian Borbjerg Laursen, Jens Søndergaard, Dorte Ejg Jabøl
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