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A detailed evaluation of risk of bias is shown in Supplementary file Tables 2 and 3

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Nicotine and other chemicals in tobacco constrict blood vessels, raise blood pressure, and promote the formation of blood clots, all of which contribute to cardiovascular complications

Initial screening visit coding: Primary diagnosis: Z12.2 (Encounter for screening for malignant neoplasm of respiratory organs) Risk factors: F17.210 (current smoker) or Z87.891 (former smoker) This applies when NO nodules are found on the screening CT Screening that identifies a nodule: Primary diagnosis: R91.1 (if solitary nodule found) or R91.8 (if multiple nodules found) Secondary diagnosis: Z12.2 can still be included to show this was a screening encounter Risk factors: Include tobacco codes Subsequent surveillance imaging: Once a nodule is found, follow-up CTs are no longer "screening",they're diagnostic surveillance