With growing interest in a centralized approach to lung cancer screening (LCS), pooling current evidence to estimate its impact on annual adherence is essential for aligning practice with guideline recommendations. Is participation in a centralized screening program associated with higher adherence rates compared to decentralized programs among individuals with negative baseline LCS results? We searched seven bibliographic databases for cohort studies published after January 1, 2011, reporting adherence outcomes for centralized versus decentralized LCS (primary outcome). Quality appraisal followed the Newcastle-Ottawa Scale for appraising observational studies. Random-effects meta-analysis was used to pool studies. Meta-regression examined patient- and institution-level characteristics associated with adherence in centralized programs. Twelve studies involving 17,195 patients with negative baseline results were included in this meta-analysis. The overall pooled adherence rate in centralized programs was 55% (95% CI: 42%-58%; 12 studies/11,302 patients) with 10-18 months of follow-up. Adherence was significantly higher in centralized compared to decentralized screening programs (68.9% vs. 37.1%; P < .0001), with a pooled OR of 3.33 (95%CI: 1.92-5.78; 4 studies/17,195 patients; moderate certainty). Substantial heterogeneity was observed across the four studies in the pairwise meta-analysis (I = 98.3%, P < .0001). Egger's regression test showed no significant funnel plot asymmetry (z = -0.374, P = .71), suggesting no evidence of publication bias. No association was found between adherence in centralized LCS and Lung-RADS category, follow-up duration, age, sex, race/ethnicity, smoking status, or institutional setting (P > .05; very low certainty). Adherence to LCS remains low but is significantly higher in centralized screening programs compared to decentralized ones. Centralization may improve equity by addressing disparities associated with patient- and institution-level characteristics. Our findings support the expansion of centralized approaches and targeted quality improvement efforts to strengthen adherence to guideline-recommended LCS.