Black Patients Less Likely To Receive Diagnostic Imaging At Emergency Departments

According to studies, black patients are less likely to receive diagnostic medical imaging during a hospital visit – and that can lead to a range of health inequalities, experts say.

X-rays, MRI exams, and other imaging are among the first lines of defense in a hospital. If patients are not offered these services in a timely manner, some conditions may go undiagnosed and can lead to complications and worse outcomes.

“We know, for example, that minorities have increased mortality from various cancers,” said Dr. Andrew Ross, assistant professor of radiology at the University of Wisconsin School of Medicine and Public Health. of cancer diagnosis. “

And he said some of the inequality could be due to the way imaging is used for Black and Latinx patients.

Studies have evaluated millions of emergency room visits, and the findings point to a striking disparity.

Ross co-authored one of these studies, which was published in the journal BMC Health Services Research. It looked at a large nationwide study of emergency room visits by adults over an 11-year period.

The results showed that patients in non-white groups were less likely to receive imaging during an emergency room visit. Black patients were 21% less likely to receive imaging – the greatest disparity among all groups.

The differences narrowed when certain factors were taken into account, Ross said.

“But they haven’t completely disappeared,” Ross said.

That suggests that race itself was a factor.

Other studies also highlight this disparity in pediatric patients.

Dr. Jennifer Marin, a pediatric physician and medical director of radiology at Children’s Hospital in Pittsburgh, co-authored a study that looked at imaging in 3.7 million visits to pediatric emergency departments across the country.

The study corrected, among other things, for clinical and demographic factors for child visits.

“And once we did, we could take a step back and say, ‘Well, the imaging rates of the races and ethnicities should really be about the same,’” said Marin.

But the study found that black children are 18% less likely to have clinical imaging than white children. According to the study, which was published in the journal JAMA Network, Latinx children are 13% less likely than white children to receive the services.

Reasons behind a complex problem

Ross and Marin’s studies were not intended to answer why this inequality exists. Both say it is a complex issue that needs further investigation.

The places where black patients seek medical care could be one reason for the inequality, Ross said.

“We know that, for example, patients and minority groups are likely to receive much of their care in hospitals with fewer resources, which may be understaffed and may not have access to certain types of advanced imaging technology,” he said.

Screening guidelines and criteria for certain diseases can also contribute to inequality. For example, Ross said that black patients are at high risk for lung cancer, but because they smoke fewer cigarettes on average, many are ineligible for lung cancer screenings.

“States with one of the highest minority populations have one of the lowest numbers of accredited sites where you can get a lung cancer screening CT,” he said.

But he cautioned that “more imaging is not necessarily a good thing” and is not the goal.

Marin agreed.

“It is possible that there is overuse and that white patients are receiving imaging that does not provide a net benefit, and we consider that to be a low value concern,” Marin said. “On the other hand, non-white patients may not be getting the imaging they should be getting. And that would indicate worse care. And it could be that both things play a part. “

Tackling inequality

This underscores the need for updated guidelines to help primary care healthcare providers make better decisions about imaging needs. That’s something Ross is working on as part of the appropriate use committee of the American College of Radiology.

Quality health insurance and access to quality primary care can help narrow these inequalities, Ross said.

The ability of a patient and their family to advocate for medical care can also play a role, and self-defense can sometimes curb unconscious bias from caregivers.

Research shows that when patients are given health information about their condition, they are better able to advocate for themselves. A study published in the journal Medical Care shows that when Hispanic women advocate for themselves, they are likely to receive better care and prescriptions and tests than white women. The study also shows that black women are the least likely group to stand up for themselves.

Health experts encourage racial minority patients to file a formal complaint if they suspect they are being discriminated against. Healthcare providers usually have a patient relations department that can address these issues, and many have diversity officers who focus on improving the experience of underrepresented patients.

Experts also advise patients to seek another provider if they feel uncomfortable or vulnerable.

Implicit health care bias can affect the type of care black Americans receive in the hospital. Marin said it’s a difficult pill to swallow for many doctors, but it’s a real problem, especially in an emergency room with a lot of stress.

“As emergency room physicians, these prejudices are actually exacerbated in times of stress,” she said. “You know, there are structural factors that are just part of the health care system that definitely affect what we do.”

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