health disparities Archives - The Imaging Wire

Cancer screening disparities continue to draw scrutiny in radiology. A new study in JAMA Network Open takes a closer look at why some people don’t get screened as often as they should – as well as the factors that contribute to cancer prevalence and mortality.

There’s extensive research backing the lifesaving potential of the major cancer screening exams, and cancer mortality rates have consistently declined thanks to the combination of screening and better treatments.

But the declines are uneven, prompting researchers to investigate reasons for the disparities, such as in a study earlier this month documenting geographic variations in cancer screening rates.

In the new study, researchers from the ACR’s Harvey L. Neiman Health Policy Institute looked at how 24 measures like lifestyle, socioeconomic status, and environmental background affected breast, prostate, lung, and colorectal cancer, which account for 50% of new cancer cases.

In particular, they examined screening completion rates and cancer prevalence and mortality at the county level in a nationally representative sample of 5% of Medicare fee-for-service beneficiaries, of whom 87% were 65 years and older.

There’s a lot to unpack in the study, but a few highlights are below as they relate to breast and lung cancer, the two cancers for which imaging-based screening is recommended. The top three factors affecting each (in order of importance) are…

Breast cancer:
- Screening rates – Hispanic population share, levels of insufficient sleep, and poverty.
- Prevalence – uninsured status, obesity, and housing insecurity.
- Mortality – non-Hispanic Black race, environmental justice index, and insufficient sleep.
Lung cancer:
- Screening rates – air pollution exposure, lack of access to primary care physicians, and number of poor physical health days.
- Prevalence – limited access to healthy foods, uninsured status, and severe housing problems.
- Mortality – smoking, poor physical health days, and environmental justice index.

While there are some obvious findings in the data (the connection between smoking and lung cancer mortality, for example), the dominance of socioeconomic measures may take some by surprise (or maybe not).

But they do track with previous research finding that socioeconomic factors account for 40-50% of health impacts.

The Takeaway

The new study – as with previous research – reinforces what we know about the strong connection between socioeconomic status and cancer screening disparities. The new data should give clinicians and public health advocates more detail on the specific factors they need to focus on to improve screening compliance and reduce cancer’s burden on society.

Patients from disadvantaged neighborhoods or those traveling farther for brain MRI scans presented in worse clinical condition than patients with better access. That’s according to a new JACR study that reopens the debate over disparities in healthcare access.

The past several years have seen numerous studies published that document disparities in healthcare access and their impact on clinical outcomes.

In radiology, most of the focus has been on screening exams for breast and lung cancer, while other research has pointed to possible solutions to improve access.

Many previous studies have also concentrated on access to care in rural areas, in which long distances make it harder for patients to travel to medical centers.

In the current study, researchers led by authors from Emory University flipped the script to examine care access in the Atlanta metropolitan area in an effort to quantify how distance and socioeconomic status might impact patient care.

They examined the demographic backgrounds of 4.8k patients who got brain MRI scans over a one-year period starting in March 2019, calculating factors like distance from home to imaging facility and socioeconomic status based on the area deprivation index.

They then correlated these data to patient illness severity – also known as acuity – when they presented for their scans, using a three-point scale ranging from normal (level 1) to findings requiring a change in patient management (level 3).

Based on the data, researchers found…

Patients in neighborhoods with lower socioeconomic status had 34% higher odds of level 2 acuity versus level 1 for inpatient scans and 27% higher for emergency scans.
Patients living twice the distance from an imaging facility had 6.5% higher odds of level 2 acuity compared to level 1, and 15% higher for level 3.
Other factors affecting acuity level included age, race, and insurance status.
Medicaid recipients in particular were sicker, with 68% higher odds of acuity level 2 and 81% higher odds of acuity level 3 compared to those with commercial insurance.

The findings track with other studies that have linked chronic health conditions with brain pathologies, such as the connection between diabetes and stroke.

The Takeaway

The new findings offer additional details on how patient demographics affect both their health status and their access to care, in particular for advanced imaging scans like brain MRI. Follow-up studies could examine whether a similar phenomenon occurs with CT, which is the workhorse modality for emergency imaging.

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