How Socioeconomic Factors Affect the Use of Medical Imaging During the Covid Pandemic

Danny Hughes
About This Project

Headshot of Danny Hughes in front of a chalkboardBy Gita Smith

Rich and poor have shown different health outcomes throughout the Covid pandemic. Access to medical imaging (CAT scans or ultrasound, for example) has proved to be important to treatment and diagnosis. A leader in examining the socioeconomic ramifications of accessing those tests is Danny Hughes, PhD, Director, Health Economics and Analytics Lab at the Georgia Institute of Technology. Together with six co-authors, Hughes has shed important light on the differential use of medical imaging by different patient demographics in emergency, clinical, and inpatient settings. His study examined and compared access to imaging in pre-Covid 2019 and post-Covid 2020. Patient data came from multiple hospitals within a large healthcare and included Black, Latino, Asian and White patients aged 18 to 80. Their health insurance varied among Medicaid, Medicare, private insurance, and no coverage.

Hughes used residential zip codes to assign median income levels to patients. The weekly total imaging volumes in 2020 and 2019 were plotted from January 1 to May 31 for different socioeconomic factors to contrast the trends during the two periods. Statistical tests comparing socioeconomic groups showed that, overall, patients with lower household income levels (under $80,000) underwent significantly more imaging while patients with higher household income (above $80,000) decreased their use of imaging during the post-Covid period. Also, older patients (aged 60-79), male patients, and non-White patients received significantly more medical imaging during the Covid-19 pandemic compared with the same weeks in the prior year. With regard to insurance status, imaging rose among Medicaid recipients and uninsured patients while those with commercial (private) insurance had significantly decreased imaging use during the same period.

The study adds valuable information to the body of knowledge about the U.S. medical response to Covid-19. It suggests that, possibly, those who were most impacted by the pandemic (older, males, non-White, and lower income) were sent for imaging more often because these patients experienced a higher prevalence of COVID-19 and were likely admitted to the hospital after being seen first in the ER. Additionally, the study showed that males had the strongest positive association, and White patients had the strongest negative association compared to other races with imaging during the pandemic, across all patient service locations. Interestingly, patients with significantly decreased outpatient imaging use during the post-COVID period were White, female, younger (under 18 and 40-59 years old), with lower income (below $60,000) and higher income ($120,000 and above).

Hughes' study Imaging Utilization During the Covid-19 Health Pandemic Highlights Socioeconomic Health Disparities appeared in the Journal of American College Radiology.