Racial and/or Ethnic Disparities in the Use of Imaging: Results from the 2015 National Health Interview Survey
2021; Radiological Society of North America; Volume: 302; Issue: 1 Linguagem: Inglês
10.1148/radiol.2021211449
ISSN1527-1315
AutoresAndrew B. Ross, Maria D. Martin, Randy C. Miles, Efrén J. Flores, Newman Kwame Boakye-Ansa, Corey Brown, Anand K. Narayan,
Tópico(s)Healthcare Policy and Management
ResumoHomeRadiologyVol. 302, No. 1 PreviousNext Original ResearchFree AccessResearch LetterRacial and/or Ethnic Disparities in the Use of Imaging: Results from the 2015 National Health Interview SurveyAndrew B. Ross, Maria Daniela Martin Rother, Randy C. Miles, Efrén J. Flores, Newman Kwame Boakye-Ansa, Corey Brown, Anand K. Narayan Andrew B. Ross, Maria Daniela Martin Rother, Randy C. Miles, Efrén J. Flores, Newman Kwame Boakye-Ansa, Corey Brown, Anand K. Narayan Author AffiliationsFrom the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.B.R., M.D.M.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.C.M.); Department of Radiology, Harvard Medical School, Harvard University, 55 Fruit St, Boston, MA 02114 (E.J.F., A.K.N.); and Meharry Medical College School of Medicine, Nashville, Tenn (N.K.B.A., C.B.).Address correspondence to A.K.N. (e-mail: [email protected]).Andrew B. RossMaria Daniela Martin RotherRandy C. MilesEfrén J. FloresNewman Kwame Boakye-AnsaCorey BrownAnand K. Narayan Published Online:Nov 2 2021https://doi.org/10.1148/radiol.2021211449MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractDownload as PowerPointIntroductionThe Institute of Medicine Report on quality of health care received by Americans who are a racial and/or ethnic minority in the United States found that racial and/or ethnic minorities experience lower quality health services and are less likely to undergo routine medical studies compared with White Americans (1). This includes diagnostic imaging; several recent studies of the emergency department setting found that racial and/or ethnic minority groups were less likely to undergo radiography, CT, and US examinations (2,3). Few nationally representative studies evaluate racial and/or ethnic disparities in use of general imaging outside of the emergency department. Our purpose was to evaluate whether there are differences in the use of CT scans and chest radiography by race/ethnicity by using nationally representative cross-sectional survey data.Materials and MethodsWe performed a retrospective analysis of the 2015 National Health Interview Survey, a nationally representative, annual federal population-based cross-sectional survey (response rate, 70.1%) (4). Our study used publicly available deidentified data and was exempt from institutional review board review. The 2015 survey was used because this was the most recent survey that reported use of imaging. Adult survey participants older than 40 years who responded to questions about use of imaging were included in our analysis. Primary outcomes included whether participants reported ever having undergone CT and self-reported use of chest radiography in the last 12 months. Multiple variable logistic regression analyses were performed to evaluate the association between use of imaging and race/ethnicity, adjusted for participant age, sex, insurance payor, education level, and household income. Statistical analyses were performed with software (Stata, version 17; StataCorp) and used survey weighting to account for the complex survey design and to obtain statistically valid estimates for the civilian, noninstitutionalized U.S. population. P values less than .05 were considered to indicate statistical significance.ResultsWith survey weighting, 149 871 555 adult participants were included (mean age, 60 years ± 13 [standard deviation]; 52% women; 71% White, 12% Hispanic, 11% Black, 5% Asian American, 1% other) (Table 1). Overall, 60 472 791 of 137 100 807 question respondents (44%) reported ever having had a CT scan, although this differed significantly by patient ethnicity with minority groups less likely to report CT use compared with White respondents even when controlling for sociodemographic factors (Tables 1, 2). For chest radiography, 29 180 832 of 137 719 660 respondents (21%) reported undergoing an examination within the last 12 months; Black respondents were more likely and Hispanic and Asian respondents were less likely than White participants to report undergoing recent chest radiography.Table 1: Sociodemographic Data of the Included Participants from the 2015 National Health Interview SurveyTable 2: Crude and Adjusted Odds Ratios for the Association of Imaging Use and Survey Participant Race and/or EthnicityDiscussionBy using nationally representative survey data, we found evidence of racial and/or ethnic disparities in use of imaging. Hispanic, Black, and Asian participants were less likely to report ever undergoing CT. Results for chest radiography were more mixed with Black participants more likely and Hispanic and Asian participants less likely to have undergone chest radiography within the last 12 months compared with White participants. Reasons for the relative increased use of chest radiography in Black patients are difficult to determine from the survey data but may include ethnicity-specific differences in disease prevalence, cultural attitudes toward different imaging modalities, or differing decision making for minority patients by ordering providers. The disparate use of CT is concordant with existing evidence of racial and ethnic disparities in use of imaging observed in other contexts. Although it is possible that this represents overuse in White patients, our results raise concern that decreased use of imaging in patients of color may contribute to the worsened health outcomes seen in these populations. Adherence to evidence-based imaging guidelines for patients of all racial and ethnic groups may help mitigate both under- and overuse of imaging and improve care (5). Further research should identify additional provider- and systems-based interventions to promote the equitable use of diagnostic imaging.Disclosures of conflicts of interest: A.B.R. No relevant relationships. M.D.M.R. No relevant relationships. R.C.M. No relevant relationships. E.J.F. Speaker honoraria from the Department of Radiology at Brown University, the LuCa National Training Network, and the National Lung Cancer Roundtable Lung Cancer Screening Update. N.K.B.A. No relevant relationships. C.B. No relevant relationships. A.K.N. No relevant relationships.Author ContributionsAuthor contributions: Guarantors of integrity of entire study, A.B.R., R.C.M., A.K.N.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, all authors; clinical studies, R.C.M., A.K.N.; experimental studies, R.C.M.; statistical analysis, A.B.R., R.C.M., A.K.N.; and manuscript editing, A.B.R., M.D.M.R., R.C.M., E.J.F., A.K.N.References1. Smedley BD, Stith AY, Nelson AR, eds; Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press, 2003. Google Scholar2. Ross AB, Kalia V, Chan BY, Li G. The influence of patient race on the use of diagnostic imaging in United States emergency departments: data from the National Hospital Ambulatory Medical Care survey. BMC Health Serv Res 2020;20(1):840. Crossref, Medline, Google Scholar3. Marin JR, Rodean J, Hall M, et al. Racial and Ethnic Differences in Emergency Department Diagnostic Imaging at US Children's Hospitals, 2016-2019. JAMA Netw Open 2021;4(1):e2033710. Crossref, Medline, Google Scholar4. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. 2015 National Health Interview Survey (NHIS) Public Use Data Release: Survey Description. https://www.cdc.gov/nchs/nhis/nhis_2015_data_release.htm Accessed May 1, 2021. Google Scholar5. Rangel EL, Cook BS, Bennett BL, Shebesta K, Ying J, Falcone RA. Eliminating disparity in evaluation for abuse in infants with head injury: use of a screening guideline. 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Crossref, Medline, Google ScholarArticle HistoryReceived: June 7 2021Revision requested: July 20 2021Revision received: Aug 14 2021Accepted: Aug 24 2021Published online: Nov 02 2021Published in print: Jan 2022 FiguresReferencesRelatedDetailsCited ByImaging Surveillance Programs: An Accessible Path to the FutureMario Enrique Mahecha Carvajal, Laura Andrea Campaña Perilla, Nelson David Bedoya Murillo, Gloria Palazuelos, Javier Andrés Romero, 20 June 2023 | Radiology, Vol. 307, No. 5Contrast-enhanced Mammography: Revisiting the Roots of ScreeningMario Enrique Mahecha Carvajal, Jairo Esteban Mahecha Carvajal, José David Cardona Ortegón, Gloria Palazuelos, Javier Andrés Romero, 27 June 2023 | Radiology, Vol. 307, No. 5Disparities in Emergency Department Waiting Times for Acute Gastrointestinal BleedingMohamadAghaie Meybodi, AmjadShaikh, RezaHashemipour, SushilAhlawat2022 | Journal of Clinical Gastroenterology, Vol. Publish Ahead of PrintRecommended Articles Narrowing the Gap: Imaging Disparities in RadiologyRadiology2021Volume: 299Issue: 1pp. 27-35Imaging Utilization and Outcomes in Vulnerable Populations during COVID-19 in New York CityRadiology: Cardiothoracic Imaging2020Volume: 2Issue: 6Deep Learning Analysis of Chest Radiographs to Triage Patients with Acute Chest Pain SyndromeRadiology2023Volume: 306Issue: 2Trends in Diagnostic Imaging Utilization among Medicare and Commercially Insured Adults from 2003 through 2016Radiology2019Volume: 294Issue: 2pp. 342-350Combining Initial Radiographs and Clinical Variables Improves Deep Learning Prognostication in Patients with COVID-19 from the Emergency DepartmentRadiology: Artificial Intelligence2020Volume: 3Issue: 2See More RSNA Education Exhibits How We Got Here: A Review Of Anti-Black Discrimination And Inequities In RadiologyDigital Posters2021Beware of The Dislodged DevicesDigital Posters2022Medical imaging AI In the Real World: Decoding Bias in Under-represented PopulationsDigital Posters2022 RSNA Case Collection Pleuropulmonary BlastomaRSNA Case Collection2021MesotheliomaRSNA Case Collection2020Pulmonary Arteriovenous MalformationRSNA Case Collection2021 Vol. 302, No. 1 Metrics Altmetric Score PDF download
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