BACKGROUND: The U.S. Preventive Services Task Force recommends annual lung cancer screening (LCS) for adults who meet specific age and smoking history criteria. OBJECTIVE: To evaluate race-, ethnicity-, and rurality-based differences in distance to the nearest LCS facility. DESIGN: Cross-sectional ecological study. SETTING: U.S. census tracts. PARTICIPANTS: 71 691 census tracts. MEASUREMENTS: The outcome variable was road network distance in miles between a census tract and the nearest LCS facility. Distance was log-transformed, and geometric means are reported. Census tracts were classified as majority (>
50%) American Indian/Alaska Native (AI/AN), Asian, Black, non-Hispanic White (NHW), no single race, or Hispanic. Rurality was defined using the rural-urban commuting area codes. Ordinary least-squares regression examined the associations between distance and census tract race, ethnicity, and rurality. RESULTS: Geometric mean distance to the nearest LCS facility was 6.5 miles. Compared with NHW-majority census tracts, distance to the nearest LCS facility was 5.26 times (426%) longer in AI/AN-majority census tracts and 7% to 39% shorter in Asian-, Black-, and Hispanic-majority census tracts. Adjustment for rurality reduced the mean distance in AI/AN-majority census tracts, but the mean distance was still 3.16 times the distance in NHW-majority census tracts. Adjustment for rurality reduced the observed advantage in Asian- and Black-majority census tracts and changed the direction of associations in Hispanic-majority census tracts. LIMITATION: Analyses did not account for travel time or cost. CONCLUSION: Differences exist in distance to LCS facilities by race and ethnicity that can only be partially explained by rurality. PRIMARY FUNDING SOURCE: Lung Ambition Alliance and the Center for Lung Research in Honor of Wayne Gittinger.