Abstract 14920: Differences in Socioeconomic Factors in Patients Obtaining Coronary Calcium Score Computed Tomography in a Large Midwestern Healthcare Network

Abstract

Introduction: Coronary artery calcium score (CACS) is an important tool for identifying subclinical atherosclerosis and cardiovascular risk stratification. The 2018 ACC/AHA Cholesterol Guideline includes CACS as a decision aid in asymptomatic, intermediate-risk patients. In most US states, including Wisconsin, CACS is not covered by insurance with out-of-pocket costs ranging from $50-400. This study aimed to examine the socioeconomic factors of Wisconsin patients who obtained a CACS CT at Advocate Aurora Health (AAH). Methods: Using the 2018 American Community Survey data from the Census Bureau, we evaluated the socioeconomic characteristics of the areas in Wisconsin where patients who underwent CACS CT at AAH lived. These included race, ethnicity, median income, median age, average household size, household without vehicles, and completion of high school. We categorized the income as low (≤$35,000), medium (>$35,000 - <$100,000), and high (≥$100,000). Additionally, we compared self-referred versus physician-referred patient characteristics. Results: A total of 19,726 patients presented for CACS CT at AAH from 2019 through 2021. The median income for patient residential areas was $73,981. The median percentage of white race in these areas was 94.6%, while that of black race was only 0.3%. Additionally, median percentage of Hispanics was 2.9%. The median average household size was 2.5 people, median percentage of households who did not own a vehicle was 2.2%, and the median high school completion rate was 95.2%. When we stratified by income, most patients were from areas with medium income (75.2%), followed by high (17.3%), and only 7.5% were from low-income areas. When comparing self-referred versus physician-referred patients, self-referred were found to live in higher-income areas compared to physicians-referred (19.4% vs. 16.4%; p<0.0001). Conclusion: Social and economic factors are well known to affect access to health care. Our study demonstrated that patients in Wisconsin who obtain out-of-pocket CACS CT live predominantly in medium and high-income areas. Patient access to preventive health care may be affected by the lack of insurance coverage.