When it comes to imaging, racial disparities persist

Research has shown that healthcare disparities exist between white and minority patients when it comes to imaging use -- particularly CT and chest x-ray, according to a letter published November 2 in Radiology.

These disparities often translate to lower quality care among the BIPOC population (Black, Indigenous, and People of Color), wrote a team led by Dr. Andrew Ross of the University of Wisconsin School of Medicine and Public Health in Madison.

"The 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 [they] experience lower quality health services and are less likely to undergo routine medical studies compared with White Americans," the group noted. "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 ultrasound examinations."

Since there has been little research based on national data that assesses these disparities outside of the emergency department, the authors conducted an analysis of the 2015 National Health Interview Survey (the most recent that reported on imaging use). They included data from approximately 150 million adults: The majority (71%) were white, while 12% were Hispanic, 11% were Black, 5% were Asian, and 1% were "other."

The team found the following:

• 44% of respondents reported having ever had a CT scan.
• 21% of survey participants reported undergoing a chest x-ray within the last 12-month period.

But there were differences in imaging use depending on race and ethnicity. Using odds ratios to measure imaging utilization (with higher values indicating increased likelihood of use), the team found that Black, Hispanic, and Asian participants were less likely to report undergoing CT than white participants. Black survey participants were more likely to have undergone recent chest x-ray compared with white counterparts, while Hispanic and Asian individuals were less likely than their white counterparts.

Odds of imaging use by race and/or ethnicity
Imaging	White	Black	Hispanic	Asian
Ever had a CT scan	Reference	0.74	0.44	0.47
Chest x-ray within 12 months	Reference	1.26	0.77	0.90

The study findings prompt several questions, Ross and colleagues noted.

"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 different decision-making for minority patients by ordering providers," they wrote.

And it's unclear whether the level of CT imaging in white patients is a sign of overuse or not.

"The disparate use of CT [among White and minority patients] is concordant with exiting evidence of racial and ethnic disparities in use of imaging observed in other contexts," the group wrote. "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."