A team of researchers is sounding an alarm that more than 70% of racial and ethnic minority patients don't receive appropriate diagnostic imaging, according to a literature review published February 22 in the Journal of the American College of Radiology.
The findings may not be surprising, but they do underscore the fact that persistent effort is needed to mitigate not only overall healthcare but specifically imaging inequities, wrote a team led by Rebecca Colwell of the University of Wisconsin-Madison.
"Our study summarizes the existing imaging literature indicating that despite continued attention, disparities based on patient race and ethnicity persist throughout radiology and our health care system," the group noted.
Imaging disparities can manifest in everything from difficulty obtaining screening exams, decreased use of appropriate imaging in the emergency department, and higher risk of receiving imaging that doesn't match current guidelines, Colwell and colleagues wrote. These problems negatively impact patient care by boosting rates of infection, disease severity, and mortality.
The investigators sought to assess imaging utilization among racial and ethnic minority patients compared to their white counterparts through a literature study that included articles from Medline, Cochrane, Web of Science, and Scopus published between January 2000 to April 2021. The team identified 206 studies that evaluated the likelihood of imaging use by patient race or ethnicity and controlled for sociodemographic factors.
Most of the studies (72%) found lower or inappropriate imaging use rates among racial and ethnic minorities. Breast cancer screening was the most common imaging setting (50%), with cancer care second (10%) and general imaging use third (9%).
"In most studies, patients of racial and ethnic minorities had decreased likelihood of imaging in comparison to white patients," Colwell's group wrote. "These disparities persisted across multiple data sources, care settings, clinical scenarios, and imaging modalities."
Of the total number of articles Colwell and colleagues reviewed, 46% found imaging disparities among minority groups even after controlling for sociodemographic factors. The authors also noted that the 206 studies reported the following specific negative outcomes due to inadequate or inappropriate imaging:
- Higher rates of breast cancer deaths among Australian Aboriginal women as the result of decreased cancer screening
- Higher mortality rates in racial and ethnic minority patients with lung cancer who had lower rates of PET/CT utilization
- Higher rates of perforated appendicitis in Black and Hispanic children who had lower rates of abdominal imaging for pain in the emergency department
Finally, the team reported that only 8% of the studies assessed strategies to address inequities in imaging in this population. Strategies included increased access to primary care physicians, compliance with appropriate imaging guidelines, and targeted outreach initiatives.
The review results may seem discouraging. But radiologists are well-placed to effectively address this kind of healthcare inequity, according to the investigators.
"Radiologists are uniquely positioned to understand the context and importance of race-based disparities in the use of medical imaging," they concluded. "Future radiology research should highlight underrepresented clinical topics, link imaging disparities to health outcomes, and explore strategies to mitigate disparities and promote an equitable health system."
