Purpose <p>Lung cancer is the leading cause of death globally. Geographic disparities in rates of lung cancer may be explained by the variation and intensity of risk factors within a given area. This study aims to advance the literature on how community-level contextual factors (i.e., environmental exposures, lung disease prevalence, and socioeconomic status) contribute to the development of lung cancer. If contextual risk factors for lung cancer can be identified, interventions can be implemented early to reduce geographic disparities of lung cancer.</p> Methods <p>This study utilizes town-level lung cancer prevalence data representing 100% of traditional Medicare beneficiaries in Connecticut, Massachusetts, New Hampshire, and Rhode Island to 1) analyze geospatial trends of lung cancer and 2) identify associated community-level risk factors. Following a series of spatial-based analyses (e.g., Moran’s I, Getis-Ord Gi*), a series of spatial regression models estimated the association of selected risk factors with lung cancer prevalence. All analyses were conducted in STATA 18 and ArcMap 10.8.</p> Results <p>A total of <i>n</i> = 49 towns were identified as lung cancer hot spots at the 95th and 99th percentiles (<i>p</i> &lt; 0.001). In regression modeling, historic releases of chromium from TRI facilities and ozone emissions, prevalence of asthma and chronic obstructive pulmonary disease (COPD), and median house values significantly predicted increased lung cancer prevalence in our sample.</p> Conclusion <p>This study found that the prevalence of lung cancer across communities can be explained, in part, by levels of environmental emissions, selected health, demographics and socioeconomic indicators.</p>