Racial, socioeconomic disparities pervade PET imaging
Use of PET among Medicare beneficiaries with cancer increased from 2004 to 2008, but the increase was not even between sociodemographic groups as the modality had higher utilization among whites and those in higher income zip codes, according to a study published in the September issue of Journal of the American College of Radiology.
Study authors Tracy Onega, PhD, of Dartmouth Medical School in Lebanon, N.H., and colleagues found the opposite to be true for CT use, however, as black patients had higher rates of CT use than white patients.
“As is often seen with health care technologies, diffusion and adoption occur unevenly, resulting in notable variation in utilization patterns,” wrote the authors.
Onega and colleagues based their findings on a retrospective national study of fee-for-service Medicare beneficiaries who had one of five cancers: head and neck, lung, esophageal, colorectal or lymphoma. PET exams covered by Medicare from 2004 through 2008 were included in the analysis.
There was an annual average of 116,452 beneficiaries with cancer, according to the study results. In 2004, the PET rate for whites was 0.35 imaging days per person-year, compared with a rate of 0.31 for blacks. The authors hypothesized that the disparity would shrink over time, as previous racial disparities in healthcare technology use had. Instead, the gap in PET use between blacks and whites grew by 2008, with PET rates increasing to 0.64 and 0.57 imaging days per person-year for whites and blacks, respectively. These trends were similar when comparing PET use of the highest quartile of median household income with the lowest quartile.
“By furthering our understanding of PET use patterns, we inferred that there are areas and populations that could likely benefit from more PET, as well as areas that may be using this costly modality at a high rate relative to other geographic areas,” wrote the authors.
High-spending Medicare hospital service areas (HSAs) also had higher adjusted PET rates compared with lower spending areas, according to the authors.
Trends were very different for other advanced imaging procedures, with MRI utilization showing no notable difference by race or socioeconomic group. CT use was higher for black than whites, and rates of PET, MRI and CT use were all higher in HSAs with higher spending. “Modality-specific differences may reflect more rapid uptake of new technologies among whites and higher income groups compared with blacks and lower income groups. It is possible that these patterns represent incomplete diffusion of the new technology and that differences will diminish over time,” wrote the authors.
Onega and colleagues speculated that underlying differences in the need for PET between racial groups—black patients are more often at later stages of cancer at diagnosis, for example—could inform the differences, but the current study was not able to address indication type.
Study authors Tracy Onega, PhD, of Dartmouth Medical School in Lebanon, N.H., and colleagues found the opposite to be true for CT use, however, as black patients had higher rates of CT use than white patients.
“As is often seen with health care technologies, diffusion and adoption occur unevenly, resulting in notable variation in utilization patterns,” wrote the authors.
Onega and colleagues based their findings on a retrospective national study of fee-for-service Medicare beneficiaries who had one of five cancers: head and neck, lung, esophageal, colorectal or lymphoma. PET exams covered by Medicare from 2004 through 2008 were included in the analysis.
There was an annual average of 116,452 beneficiaries with cancer, according to the study results. In 2004, the PET rate for whites was 0.35 imaging days per person-year, compared with a rate of 0.31 for blacks. The authors hypothesized that the disparity would shrink over time, as previous racial disparities in healthcare technology use had. Instead, the gap in PET use between blacks and whites grew by 2008, with PET rates increasing to 0.64 and 0.57 imaging days per person-year for whites and blacks, respectively. These trends were similar when comparing PET use of the highest quartile of median household income with the lowest quartile.
“By furthering our understanding of PET use patterns, we inferred that there are areas and populations that could likely benefit from more PET, as well as areas that may be using this costly modality at a high rate relative to other geographic areas,” wrote the authors.
High-spending Medicare hospital service areas (HSAs) also had higher adjusted PET rates compared with lower spending areas, according to the authors.
Trends were very different for other advanced imaging procedures, with MRI utilization showing no notable difference by race or socioeconomic group. CT use was higher for black than whites, and rates of PET, MRI and CT use were all higher in HSAs with higher spending. “Modality-specific differences may reflect more rapid uptake of new technologies among whites and higher income groups compared with blacks and lower income groups. It is possible that these patterns represent incomplete diffusion of the new technology and that differences will diminish over time,” wrote the authors.
Onega and colleagues speculated that underlying differences in the need for PET between racial groups—black patients are more often at later stages of cancer at diagnosis, for example—could inform the differences, but the current study was not able to address indication type.
Evan Godt, Writer
Evan joined TriMed in 2011, writing primarily for Health Imaging. Prior to diving into medical journalism, Evan worked for the Nine Network of Public Media in St. Louis. He also has worked in public relations and education. Evan studied journalism at the University of Missouri, with an emphasis on broadcast media.