Imaging Utilization During the COVID-19 Pandemic Highlights Socioeconomic Health Disparities

Abstract

Objective: The devastating impact from the coronavirus disease 2019 (COVID-19) pandemic highlights long-standing socioeconomic health disparities in the United States. The purpose of this study was to evaluate socioeconomic factors related to imaging utilization during the pandemic.Methods: Retrospective review of consecutive imaging examinations was performed from January 1, 2019, to May 31, 2020, across all service locations (inpatient, emergency, outpatient). Patient level data were provided for socioeconomic factors (age, sex, race, insurance status, residential zip code). Residential zip code was used to assign median income level. The weekly total imaging volumes in 2020 and 2019 were plotted from January 1 to May 31 stratified by socioeconomic factors to demonstrate the trends during the pre-COVID-19 (January 1 to February 28) and post-COVID-19 (March 1 to May 31) periods. Independent-samples t tests were used to statistically compare the 2020 and 2019 socioeconomic groups.Results: Compared with 2019, the 2020 total imaging volume in the post-COVID-19 period revealed statistically significant increased imaging utilization in patients who are aged 60 to 79 years (P ¼ .0025), are male (P < .0001), are non-White (Black, Asian, other, unknown; P < .05), are covered by Medicaid or uninsured (P < .05), and have income below $80,000 (P < .05). However, there was a significant decrease in imaging utilization among patients who are younger (<18 years old; P < .0001), are female (P < .0001), are White (P ¼ .0003), are commercially insured (P < .0001), and have income $80,000 (P < .05).

The global impact of the COVID-19 pandemic on clinical radiography practice: A systematic literature review and recommendations for future services planning

“…Our findings highlight prior knowledge to indicate that radiography practice varies widely across different settings and among countries, often due to differences in both expert human and physical resource availability. 8 , 34 , 35 , 36 , 37 , 61 , 74 As medical imaging has played an important role in both the diagnosis and management of COVID-19 patients, the pandemic has highlighted existing global discrepancies in radiography resource availability. 35 , 37 , 61 , 74 The findings suggest that the knowledge-base of radiographers about the pandemic has improved over time.…”

“… 8 , 34 , 35 , 36 , 37 , 61 , 74 As medical imaging has played an important role in both the diagnosis and management of COVID-19 patients, the pandemic has highlighted existing global discrepancies in radiography resource availability. 35 , 37 , 61 , 74 The findings suggest that the knowledge-base of radiographers about the pandemic has improved over time. For example, Kotian and colleagues 11 reported relatively low knowledge of COVID-19 among India's radiography workforce at the initial stages of the pandemic (March, 2020), similar to the baseline findings reported among their Irish counterparts at approximately the same period of the pandemic.…”

“…75 These improvements are attributable to improved communication, training, and public campaigns on the pandemic. 7 , 8 , 9 , 10 , 74 , 75…”

Impact of the COVID-19 pandemic on radiology department emergency ultrasound utilization

“…An association between male gender and COVID-19 infection, severity of disease, and hospitalization rate has been highlighted since early in the course of the pandemic [ 20 – 22 ]. A positive association between male gender and imaging utilization during the COVID pandemic has also been described [ 23 ]. In our study, we see a higher proportion of ultrasounds performed in men during the COVID time period compared to the pre-pandemic period.…”

“…An association between male gender and COVID-19 infection, severity of disease, and hospitalization rate has been highlighted since early in the course of the pandemic [20][21][22]. A positive association between male gender and imaging utilization during the COVID pandemic has also been described [23].…”