Impact of Socioeconomic Status on Ionizing Radiation Exposure From Medical Imaging in Children

Abstract

Purpose To characterize cumulative exposure to ionizing radiation from diagnostic imaging (CEDI) in pediatric patients, and investigate its relationship to patients’ socioeconomic status (SES) and comorbid medical conditions (CMC). Methods An IRB approved HIPAA compliant retrospective cohort study of 19,000 pediatric patients seen within the outpatient clinic system of an academic tertiary care urban medical center during the month of January 2006, that estimated the CEDI from all procedures performed within three years of the index visit (until January 2009). SES was estimated from census tract geocoding. CMC were identified from the electronic medical record. Results 19063 patients had an imaging test within the index month. Mean age was 8.9 years (SD=6.3). Most had private insurance (56%), with 36% receiving Medicaid and 8% private payors. 27% (SD=16) reside in poverty areas, with 62% living in areas of which more than 20% of residents were living below the poverty level. There were differences in CEDI (p<.0001) by age, insurance type, and percent poverty in census tract of residence, but not among racial groups (p=.6508). The association between poverty and CEDI was generally explained by the 26 Elixhauser diagnoses with the exception of rheumatoid arthritis (RA). Conclusion Patients living in areas of greater poverty were exposed over time to more radiation from diagnostic testing than those living in areas with a lower percentage of residents living in poverty. This association was explained almost entirely by the presence of disease burden. We found no direct association between SES and CEDI.

Glioma incidence and survival variations by county‐level socioeconomic measures

“…Exposure to ionizing radiation has been shown to increase risk, 31,32 whereas atopic disease may have protective effects. Exposure to ionizing radiation has been shown to increase risk, 31,32 whereas atopic disease may have protective effects.…”

“…To the best of our knowledge, there currently is little evidence for factors that modify the risk of glioma. Exposure to ionizing radiation has been shown to increase risk, 31,32 whereas atopic disease may have protective effects. 6 Although both of these may be correlated with SES, this confounding is unlikely to explain the relatively large differences in incidence reported herein.…”

Improving Imaging Care for Diverse, Marginalized, and Vulnerable Patient Populations

“…to ionizing radiation in the form of diagnostic imaging (43). It is important for the health care provider to recognize implicit biases that may be directed toward patients of low socioeconomic status to help reduce health care disparities (44).…”

The Impact of Race on the Prognosis of Preclinical Diastolic Dysfunction: A Large Multiracial Urban Population Study

“…15 This method is used by Clinical Looking Glass and has been previously validated against the US Census Bureau geocoding database. 16 Patient information was deidentified in accordance with the Health Insurance Portability and Accountability Act. The Institutional Review Board of Montefiore Medical Center and Albert Einstein College of Medicine approved this study.…”

“…The Institutional Review Board of Montefiore Medical Center and Albert Einstein College of Medicine approved this study. 15,16 Echocardiography Echocardiography was performed according to the guidelines of the American Society of Echocardiography using Sonos 5500, Sonos 7500, or IE-33 ultrasound systems (Philips Healthcare, Andover, MA). 17 Left ventricular ejection fractions were calculated using either biplane Simpson's method or Teichholz formula.…”