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Utilization patterns of diagnostic imaging across the late life course: A population-based study in Ontario, Canada

Published online by Cambridge University Press:  01 October 2008

Li Wang ,
Jason X. Nie ,
C. Shawn Tracy ,
Rahim Moineddin  and
Ross E. G. Upshur
Li Wang
Affiliation:
Sunnybrook Health Sciences Centre
Jason X. Nie
Affiliation:
Sunnybrook Health Sciences Centre
C. Shawn Tracy
Affiliation:
Sunnybrook Health Sciences Centre
Rahim Moineddin
Affiliation:
University of Toronto and Sunnybrook Health Sciences Centre
Ross E. G. Upshur
Affiliation:
University of Toronto and Sunnybrook Health Sciences Centre
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Abstract

Objectives: Due to the aging baby boom population, utilization rates of diagnostic imaging (i.e., X-ray, CT, and MRI scanning) have risen rapidly relative to other health services. The aim of this study is to investigate the utilization patterns of outpatient diagnostic imaging services (X-ray, CT, and MRI) across the late life course (65 years and older).

Methods: A population-based retrospective cohort study was conducted for the period April 1, 2005, to March 31, 2006. All Ontario residents aged 65+ and eligible for government health insurance were included in the analysis.

Results: Utilization of diagnostic imaging followed an inverted U-pattern: increasing with advancing age, peaking in the 80–84 age group for CT scans and in the 70–74 age group for MRI and X-rays, and then declining in the later years. Overall, females received significantly more X-rays than males (p < .01), but males received significantly more CT and MRI scans (p < .01). A small proportion of high-users of radiology services accounted for a large proportion of overall utilization. Finally, our analysis revealed that a disproportionately large proportion of high-users of MRI services were in the highest SES quintile. No SES differences were observed for X-ray or CT scans.

Conclusions: Population aging will lead to increased demand for healthcare services. Utilization of outpatient diagnostic imaging services is associated with age, gender, and SES. Given the increasing demand and the limited resources available, there may be a need for programs to target underserved populations to reduce remediable inequities. Whereas patient-level decisions regarding the use of diagnostic imaging are rightfully determined on the basis of clinical factors, allocation decisions should also be informed by the ethical principles of equity and fairness.

Keywords

Diagnostic imagingEpidemiologyUtilizationHealth services for the aged
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 24 , Issue 4 , October 2008 , pp. 384 - 390
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

1. Alter, DA, Naylor, CD, Austin, PC, Chan, BT, Tu, JV. Geography and service supply do not explain socioeconomic gradients in angiography use after acute myocardial infarction. CMAJ. 2003;168:261–264.Google Scholar
2. Borkhoff, CM, Hawker, GA, Kreder, HJ et al. The effect of patients' sex on physicians' recommendations for total knee arthroplasty. CMAJ. 2008;178:681–687.CrossRefGoogle ScholarPubMed
3. Canadian Institute for Health Information. Medical imaging in Canada 2004. Ottawa: Canadian Institute for Health Information; 2004:38–39.Google Scholar
4. Demers, M. Frequent users of ambulatory health care in Quebec: The case of doctor-shoppers. CMAJ. 1995;153:37–42.Google Scholar
5. Demeter, S, Reed, M, Lix, L, MacWilliam, L, Leslie, WD. Socioeconomic status and the utilization of diagnostic imaging in an urban setting. CMAJ. 2005;173:1173–1177.CrossRefGoogle Scholar
6. Fowler, RA, Sabur, N, Li, P et al. Sex-and age-based differences in the delivery and outcomes of critical care. CMAJ. 2007;177:1513–1519.CrossRefGoogle ScholarPubMed
7. Freeborn, DK, Pope, CR, Mullooly, JP, McFarland, BH. Consistently high users of medical care among the elderly. Med Care. 1990;28:527–540.CrossRefGoogle ScholarPubMed
8. Frohlich, N, Fransoo, R, Roos, N. Health service use in the Winnipeg Regional Health Authority: Variations across areas in relation to health and socioeconomic status. Healthc Manage Forum. 2002;Winter (suppl):9–14.Google Scholar
9. Glazier, RH, Tepper, J, Agha, MM, Moineddin, R. Primary care in disadvantaged populations. In: Jaakkimainen, L, Upshur, R, Klein-Geltink, JE, Leong, A, Maaten, S, Schultz, S, Wang, L, eds. Primary care in Ontario: ICES Atlas. Toronto: Institute for Clinical Evaluative Sciences; 2006.Google Scholar
10. Krieger, N. Overcoming the absence of socioeconomic data in medical records: Validation and application of a census-based methodology. Am J Public Health. 1992; 82:703–710.CrossRefGoogle ScholarPubMed
11. Kung, PT, Tsai, WC, Yaung, CL, Liao, KP. Determinants of computed tomography and magnetic resonance imaging utilization in Taiwan. Int J Technol Assess Health Care. 2005;21:81–88.CrossRefGoogle ScholarPubMed
12. Laupacis, A, Keller, MA, Przybysz, R. CT and MRI scanning. In: Tu, JV, Pinfold, SP, McColgan, P, Laupacis, A, eds. Access to health services in Ontario: ICES Atlas. Toronto: Institute for Clinical Evaluative Sciences; 2005.Google Scholar
13. Laupacis, A, Evans, W. Diagnostic imaging in Canada. Healthc Pap. 2005;6:8–15.CrossRefGoogle ScholarPubMed
14. Laupacis, A, Przybysz, R, Keller, MA. CT and MRI scanning. In: Tu, JV, Pinfold, SP, McColgan, P, Laupacis, A, eds. Access to health services in Ontario: ICES Atlas, 2nd ed. Toronto: Institute for Clinical Evaluative Sciences; 2006.Google Scholar
15. Lysdahl, KB, Børretzen, I. Geographical variation in radiological services: A nationwide survey. BMC Health Serv Res. 2007;7:21.CrossRefGoogle ScholarPubMed
16. Mustard, CA, Derksen, S, Berthelot, JM, Wolfson, M. Assessing ecologic proxies for household income: A comparison of household and neighbourhood level income measures in the study of population health status. Health Place. 1999;5:157–171.CrossRefGoogle Scholar
17. Nie, JX, Wang, L, Tracy, CS, Moineddin, R, Upshur, REG. Health care service utilization among the elderly findings from the study to understand the chronic condition experience of the elderly and the disabled (SUCCEED project). J Eval Clin Pract. In press.Google Scholar
18. Noseworthy, T. Further reflections on diagnostic imaging in Canada. Healthc Pap. 2005;6:24–27.CrossRefGoogle ScholarPubMed
19. Ontario Association of Radiologists. The wait goes on: Ontario's radiology waiting list crisis update 2004. Oakville: September 2004. http://www.oar.info/pdf/WaitLISTRELEASE09-04.pdf. Accessed 10 July 2008.Google Scholar
20. Reid, R, Evans, R, Barer, M. Conspicuous consumption: Characterizing high users of physician services in one Canadian province. J Health Serv Res Policy. 2003;8:215–224.Google Scholar
21. Roos, NP, Mustard, CA. Variation in health and health care use by socioeconomic status in Winnipeg, Canada: Does the system work well? Yes and no. Milbank Q. 1997;75:89–111.Google Scholar
22. Rosen, MP, Davis, RB, Lesky, LG. Utilization of outpatient diagnostic imaging. Does the physician's gender play a role? J Gen Intern Med. 1997;12:407–411.CrossRefGoogle ScholarPubMed
23. Stein, LA. Making the best use of radiological resources in Canada. Healthc Pap. 2005;6:18–21.CrossRefGoogle ScholarPubMed
24. Vrbova, L, Mamdani, M, Moineddin, R, Jaakimainen, L, Upshur, RE. Does socioeconomic status affect mortality subsequent to hospital admission for community acquired pneumonia among older persons? J Negat Results Biomed. 2005;4:4.CrossRefGoogle ScholarPubMed
25. You, JJ, Alter, DA, Iron, K et al. Diagnostic services in Ontario: Descriptive analysis and jurisdictional review. Toronto: Institute for Clinical Evaluative Sciences; 2007.Google Scholar