Access and equity in use of diagnostic imaging in Brazil: a longitudinal ecological study

Abstract

BackgroundHigh-cost health-care technologies have become more widely available in Brazil in the public health system. We evaluated the equity of access to MRI and CT examinations in recent years. MethodsWe did this longitudinal ecological study with secondary data from DATASUS. We extracted municipality-level data for use of MRI and CT as the ratio between the number of MRI and CT examinations in a municipality divided by the total population of the same municipality. The municipalities were grouped by income quintiles of the Human Development Index in 2000, which was used as baseline, we assessed trends in use according to these quintiles for 2008–12. FindingsMRI and CT are used more often in municipalities with higher Human Development Indices. For 2008–12, the number of examinations per 1000 inhabitants of municipalities in the lowest Human Development Index quintile increased from 0·39 to 1·08 for MRI and from 2·46 to 4·38 for CT. In municipalities in the highest Human Development Index quintile, the number of scans increased from 2·22 to 4·53 for MRI and from 11·17 to 18·99 for CT, over the same period. Although use has increased over time for all Human Development Index quintiles (by 178% for MRI and 78% for CT in the first quintile; 91% and 77%, respectively, in the second quintile; 146% and 83%, respectively, in the third quintile; 139% and 87%, respectively, in the fourth quintile; and 104% and 70%, respectively, in the fifth quintile), inequalities increased from 2008 to 2012 (difference between ratios of examinations between fifth and first quintiles for MRI was 1·83 in 2008 versus 3·45 in 2012 [p<0·0001], and for CT it was 8·71 in 2008 versus 14·61 in 2012 [p<0·0001]). The Pearson's correlation coefficient for the difference between fifth and first quintiles and the period was 0·99 for MRI and 0·98 for CT (p<0·001). InterpretationIncreased access to MRI and CT in recent years in Brazil has not reduced inequalities in the use of these technologies in municipalities. FundingNone.