Patients from poorer neighborhoods travel farther for MRIs, show up in worse condition
Patients from poorer communities often must travel farther for brain MRIs and show up in worse condition, according to new research.
Individuals arriving for imaging from neighborhoods with a lower socioeconomic status—a metric incorporating income, education and employment—had significantly higher acuity on both inpatient and emergency room scans. Even a twofold increase in distance traveled from home to an imaging center resulted in substantially higher severity in these patients’ conditions, researchers detailed Oct. 9 in JACR.
Experts believe their findings underscore that healthcare inequities persist, even in metro areas where imaging is widely available.
“These results motivate future work into the effects of nonmedical factors on healthcare outcomes and may have implications on health policy from the lens of insurance, triage protocols, and screening in clinical practice to mitigate the effects on acuity,” corresponding author Candace C. Fleischer, PhD, an associate professor in the Department of Radiology and Imaging Sciences at Emory University, Atlanta, and colleagues wrote Thursday.
The study incorporated brain scans performed on over 4,800 individuals at Emory between 2019 and 2020. Neighborhood socioeconomic status was quantified using area deprivation index, a measure that ranks communities based on disadvantage. Meanwhile, board certified neuroradiologists categorized each scans’ acuity on a 3-point scale, with 3 representing most severe.
Patients typically traveled a median distance of about 19.8 miles to receive their brain MRI, the study found. Those who traveled from poorer communities (as defined by area deprivation index) or from farther distances showed up in significantly worse condition. Lower neighborhood socioeconomic status also markedly increased the odds of higher acuity across both inpatient and emergency settings. Just one standard deviation increase in area deprivation index—i.e., lower neighborhood socioeconomic status—resulted in a 34% uptick in the odds of inpatients ranking acuity 2 on the scale. For ED visitors, the increase was approximately 27%.
“These acute conditions may be further exacerbated by mental stress associated with living in neighborhoods with heightened crime. Furthermore, several studies have linked chronic health conditions to acute brain pathologies,” the authors noted, giving the example of how diabetes may increase one’s risk of stroke. “Combined with our findings related to the influence of neighborhood [socioeconomic status] on acuity, the collective evidence reinforces the effects of environmental and socioeconomic disparities, which can manifest as poor overall health outcomes and neurological vulnerabilities contributing to higher acuity of brain MRI scans.”
Fleischer and colleagues also noted their findings may signal some low-income patients may be delaying medical care due to financial constraints and limited access to imaging. For uninsured patients, out-of-pocket expenses can be substantial.
“The present findings may inform hospital policies by supporting risk stratification approaches to account for lower [socioeconomic status], as well as targeted resource allocation toward encounter types, such as inpatient care, where SES-related differences in acuity are more pronounced,” the authors advised. “Finally, we observed patients with Medicaid had higher acuity compared to patients with commercial insurance, consistent with our findings related to SES as Medicaid eligibility is largely based on income,” they added later. “Our findings showing the influence of SES on acuity may explain why individuals with Medicaid may present with higher acuity compared to individuals with commercial insurance.”
Read more, including potential study limitations, in the Journal of the American College of Radiology.
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.