Key PointsQuestionAre there racial disparities in initial lung cancer screening rates among veterans referred for screening after adjusting for various demographic and socioeconomic risk factors?FindingsIn this cross-sectional study of 4562 veterans eligible for and referred for lung cancer screening at the Durham Veterans Affairs Health Care System, Black veterans had significantly lower odds of completing lung cancer screening even after adjusting for various demographic and socioeconomic risk factors.MeaningThese findings suggest that Black veterans have lower rates of lung cancer screening that are not fully explained by demographic and socioeconomic variables, underscoring the need for further qualitative studies on barriers to lung cancer screening as well as evidence-based interventions targeted to Black veterans.