The impact of rurality, socioeconomic status, and health literacy on lung cancer screening uptake: a systematic review protocol.

Background: Lung cancer is the leading cause of cancer-related mortality in the United States (U.S.). The United States Preventive Services Task Force (USPSTF) recommends lung cancer screening with low-dose computed tomography (LDCT) for individuals at high risk for lung cancer to improve early detection and survival rates. Despite strong evidence supporting lung cancer screening, its adoption remains low. Participation rates range from only 1% to 16% of those eligible across different geographic regions. Further, rural populations may face significant barriers to lung cancer screening access due to factors such as geographic isolation, socioeconomic status (SES), and health literacy. Methods: We propose a systematic review to examine how rurality, SES, and health literacy independently and collectively influence lung cancer screening utilization rates in the U.S. Using the Sample, Phenomenon of Interest, Design, Evaluation and Research (SPIDER) framework, this review will synthesize findings from research studies published between the years 2014 to 2024. The review will explore the barriers to screening uptake, including limited healthcare infrastructure, financial constraints, and inadequate awareness or understanding of lung cancer screening guidelines. Discussion: The findings of this systematic review are intended to influence policies that enhance accessibility, affordability, and education surrounding lung cancer screening to improve outcomes for rural populations. Registration: PROSPERO Registration: CRD42025644774.