COVID-19 pandemic is significantly shifting the socioeconomic mix of patients using imaging
The COVID-19 pandemic is significantly shifting the socioeconomic mix of patients utilizing radiology services, a trend that warrants attention from practice leaders and policymakers alike, experts reported Wednesday.
In particular, racial minority groups, patients in lower income brackets, and those on Medicaid or without insurance have used imaging at a much higher clip than prior to the crisis. And they did so in emergency or inpatient settings, signaling a higher prevalence of the novel coronavirus in such populations, noted experts with New York-based hospital giant Northwell Health.
“The COVID-19 pandemic has highlighted long-standing health disparities in the U.S. and has had a disproportionate impact on the health and well-being of individuals of lower socioeconomic status, thus compounding the preexisting inequities in the U.S. healthcare system,” Jason Naidich, MD, MBA, chair of radiology at the Zucker School of Medicine at Northwell/Hofstra, and colleagues wrote Oct. 28 in JACR. “The findings from this study revealed statistically significant changes in the composition mix of the socioeconomic factors of patients undergoing imaging during the COVID-19 pandemic.”
Much has been written in recent months about COVID’s impact on imaging volumes, along with minority populations. The former includes another study from Naidich back in May, which found massive declines in imaging visits during the early days of the crisis.
Wanting to marry these two concerns, researchers retrospectively analyzed radiology invoices in Northwell’s charge master, logged between January 2019 and May 2020. They further pinpointed the location where patients received care, along with billing information to determine insurance type and demographic data.
Bottom line: Naidich et al. determined that older (between the ages of 60-79), nonwhite, and male patients received significantly more imaging between March and May when compared to the same period in 2019. Same goes for individuals without insurance or on Medicaid.
On the flipside, female, younger (under 18), those between ages 40-59, white, lower income (earning less than $60,000) and higher income (greater than $120,000) patients used significantly fewer imaging resources, year over year. Naidich and colleagues speculated that this trend was caused by patients postponing outpatient imaging services amid widespread shutdowns in nonurgent care; the declines were particularly significant among breast cancer screenings. The research team additionally noted that the COVID-related economic downturn has resulted in high rates of unemployment and loss of insurance, “which may have disproportionately impacted those patients with prior commercial insurance and lower income households.”
“We also consider the possibility that these findings can be explained by the preexisting disparities related to imaging services reported in the literature, in particular to cancer screening and follow-up imaging,” Naidich et al. wrote. “If this is indeed the case, this delayed care may lead to potential adverse health consequences for these populations.
Understanding the impact of the decline in the utilization of imaging services for specific patient groups is important to better guide health policy during and after the pandemic to ensure imaging needs are met,” the authors added. “If this issue is not addressed proactively, it may potentially result in widening of existing disparities in radiology in the post-pandemic era that includes access to outpatient imaging services, especially cancer screening programs.”
You can read more of the analysis in the Journal of the American College of Radiology here. Others contributing to the piece included Siemens Medical Solutions, and the Harvey L. Neiman Health Policy Institute.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.