E1518. Disparities and Social Determinants of Health in Imaging Utilization: What the Radiologist Needs to Know
  1. Mohab Elmohr; Baylor College of Medicine
  2. Zulqarnain Javed; Houston Methodist Hospital
  3. Prachi Dubey; Houston Methodist Hospital
  4. John Jordan; Providence Little Company of Mary Medical Centere; Standford University
  5. Lubdha Shah; University of Utah
  6. Khurram Nasir; Houston Methodist Debakey Heart and Vascular Institute; Houston Methodist Hospital
  7. Christie Lincoln; Baylor College of Medicine
Disparities in health care and patient outcomes are pervasive across diseases and established in a growing body of literature. Outcome disparities are a culmination of a breakdown in the care continuum at various steps in the process, including in sub-specialized services such as imaging, where inequitable access to medically indicated imaging is evident across conditions such as stroke, emergency care, and cancer screening. The conditions in which people are born, live, work, and age –collectively known as social determinants of health (SDOH) – are primary drivers of health outcome inequities. The extent to which SDOH affect access and use of imaging services and downstream patient outcomes is not fully understood.

Educational Goals / Teaching Points
Review the five domains of SDOH, explore the impact of social determinants of health on imaging utilization, and understand the interaction between SDOH and the imaging cycle.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Low socioeconomic status (SES) is associated with delayed diagnosis of breast, and delayed access to critical imaging resources for early diagnosis and management of stroke. Individuals with low SES are also less likely to undergo lung cancer screening. Higher educational attainment is associated with greater adherence to breast and lung cancer screening and timely diagnosis of stroke. Neighborhood and built environment are related to the likelihood of undergoing breast and lung cancer screening, with urban residents more likely to be under-screened for lung cancer. Social capital is associated with awareness and adherence to breast cancer screening. Healthcare access and quality are highly affected by insurance status, racial background, and rural location, with subsequent decreased likelihood of undergoing breast or lung cancer screening or receive stroke imaging.

The impact of SDOH domains on imaging utilization on three primary imaging areas, i.e., lung and breast cancer screening and stroke services, demonstrates strong evidence supporting the deleterious impact of adverse SDOH on screening mammogram utilization; however, there is a dearth of evidence evaluating the impact of SDOH domains on lung cancer screening utilization and stroke imaging.