Abstract
Recent publications reported that children in disadvantaged areas undergo more CT scanning than others. The present study is aimed to assess the potential differences in CT imaging by socioeconomic status (SES) in Spanish young scanned subjects and if such differences vary with different indicators or different time point SES measurements. The associations between CT scanning and SES, and between the CT scan rate per patient and SES were investigated in the Spanish EPI-CT subcohort. Various SES indicators were studied to determine whether particular SES dimensions were more closely related to the probability of undergoing one or multiple CTs. Comparisons were made with indices based on 2001 and 2011 censuses. We found evidence of socio-economic variation among young people, mainly related to autonomous communities of residence. A slightly higher rate of scans per patient of multiple body parts in the less affluent categories was observed, possibly reflecting a higher rate of accidents and violence in these groups. The number of CT scans per patient was higher both in the most affluent and the most deprived categories and somewhat lower in the intermediate groups. This relation varied with the SES indicator used, with lower CT scans per patients in categories of high unemployment and temporary work, but not depending on categories of unskilled work or illiteracy. The relationship between these indicators and number of CTs in 2011 was different than that seen with the 2001 census, with the number of CTs increasing with higher unemployment. Overall we observed some differences in the SES distribution of scanned patients by Autonomous Community in Spain. There was, however, no major differences in the frequency of CT scans per patient by SES overall, based on the 2001 census. The use of different indicators and of SES data collected at different time points led to different relations between SES and frequency of CT scans, outlining the difficulty of adequately capturing the social and economic dimensions which may affect health and health service utilisation.
Highlights
Almost 4 million computed tomography (CT) scans are performed annually in Spain [1], allowing for non-invasive detailed imagery of human anatomical inner structures
Over 79.7% (123,729 individuals) of the 155,309 children and young adults who received at least one CT scan between 1991 and 2013 in the participating hospitals and resided within the 5 autonomous communities (AC) had sufficient data to geocode their address to the census-tract level
When the relationship between socioeconomic status (SES) and CT scan rate per patient was studied by AC, differences were observed: in Catalonia a decreasing rate of CT scans per patient was observed with decreasing SES, while in Madrid community the decrease was only in the lowest socioeconomic groups
Summary
Almost 4 million computed tomography (CT) scans are performed annually in Spain [1], allowing for non-invasive detailed imagery of human anatomical inner structures. The low to moderate doses of ionising radiation imparted in CT scanning have been associated with an increased risk of brain tumours and leukaemia in children and young adults [2,3,4,5]. Four recent papers have reported higher radiation doses and CT scan use in children living in disadvantaged areas [6,7,8,9]. Recent studies have challenged this long-held view associating higher childhood leukaemia rates with less affluent individuals [13]. Higher disease rates where associated with lower SES levels when individual–level measures of family income, mother’s education and father’s education were used. Occupational class, whether measured at the ecological or individual level, was positively associated with childhood leukaemia [14]. Different SES indicators could be capturing diverse risk factors, potentially explaining some of the observed differences in between studies
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