African American Patients One-Third Less Likely to Receive Advanced Imaging in Emergency Department

African American Medical recipients are nearly one-third less likely than their white counterparts to undergo advanced imaging – CT or MRI studies – in the emergency department (ED) setting, according to a new study.

In an article published online Dec. 23 in the American Journal of Roentgenology, a multi-institutional team led by Tarek N. Hanna, M.D., an associate professor of diagnostic imaging with expertise in emergency and trauma imaging at Emory University Midtown Hospital, revealed a variety of imaging inequities across the country.

“We believe that [our] observations have broad health care and health care equity implications, particularly because ED visits among the Medicare fee-for-service population are rising, as is the associated ED imaging of this population,” the team wrote.

According to a 2019 American Journal of Roentgenology study, more and more Medicare beneficiaries are relying on the ED for their healthcare needs. In fact, annually, this group accounts for nearly 22 million ED visits, so pinpointing what inequalities exist and identifying ways to rectify those differences could have a significant impact on patient outcomes, the team said.

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Overall, the team hypothesized that advanced imaging utilization in the ED would differ according to hospital location, hospital status, and patient race and postulated learning more could lead to creating targeted interventions and shed light on how expanded coverage through Medicare-for-All insurance could affect these disparities.

For their study, the team retrospectively reviewed the records from 86,976 ED encounters from Medicare beneficiaries, focusing on CT and MRI. Of the population, nearly 61 percent were encounters for women, 29 percent were from rural hospitals, and approximately 16 percent occurred in critical access hospitals. Their review unveiled several inequalities in advanced imaging utilization.

Based on a fully adjusted multivariate logistic regression analysis, Hanna’s team determined that African American patients were 31.6 percent less likely than white patients to receive advanced imaging. In addition, rural patients – both African American and white – and those in critical care access hospitals were 6.9 percent and 18 percent, respectively, less likely than urban and those in non-critical care access facilities to receive these types of imaging. However, only white and patients who were categorized as Asian, Hispanic, Native American, other, or unknown were less likely to be imaged in a critical care hospital.

Gender also played a role, the team said, but only among African American patients. African American men were 15.9 percent less likely to received advanced imaging in the ED than were African American women. Geography was also a factor. Patients in critical access hospitals had lower odds of receiving advanced imaging in the Midwest and West; men were less likely in the Northeast; and African Americans were less likely in all regions.

Overall, they said, these results show that even routine courses of action in the ED have not been able to erase the presence of inequities in medical imaging.

“In EDs, one might expect that defined evidence-based imaging protocols would minimize health care disparities,” they said. “However, the persistence of these disparities for different populations (particularly with similar Medicare fee-for-service insurance coverage) is consistent with the complex nature of this problem, importantly, both unconscious bias and conscious bias may play a role in health care inequity.”

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In fact, they said, standardizing ED imaging utilization and documenting guideline compliance could be an effective tactic for reducing these disparities. But, still, they asserted, further research is necessary to explain why the disparities exist, to examine the implications for patient outcomes, and to assess proposed interventions