Regional Deprivation and Non-Cancer Related Computed Tomography Use in Pediatric Patients in Germany: Cross-Sectional Analysis of Cohort Data.

Steffen Dreger,Hajo Zeeb,Werner Maier,Roman Pokora,Lucian Krille,Maria Blettner

doi:10.1371/journal.pone.0153644

Abstract

BackgroundConflicting findings were observed in recent studies assessing the association between patients’ area-level socio-economic status and the received number of computed tomography (CT) examinations in children. The aim was to investigate the association between area-level socio-economic status and variation in CT examination practice for pediatric patients in Germany.MethodsData from Radiology Information Systems for children aged 0 to < 15 years without cancer who had at least one CT examination between 2001 and 2010 were extracted in 20 hospitals across Germany. The small-area German Index of Multiple Deprivation (GIMD) was used to assess regional deprivation. The GIMD scores were classified into least, medium and most deprived areas and linked with the patient’s last known postal code. A multinomial logistic regression model was used to assess the association between patients’ CT numbers and regional deprivation adjusting for age, sex, and location of residence (urban/rural).ResultsA total of 37,810 pediatric patients received 59,571 CT scans during the study period. 27,287 (72%) children received only one CT, while n = 885 (2.3%) received six or more. Increasing numbers of CT examinations in non-cancer patients were significantly associated with higher regional deprivation, which increased, although CI overlap, for higher CT categories: ‘2–3 CT’ odds ratio (OR) = 1.45, 95%CI: 1.40–1.50; ‘4–5 CT’ OR = 1.48, 95%CI: 1.38–1.59; ‘6+CT’ OR = 1.54, 95%CI: 1.41–1.69. In addition, male sex, higher age categories, and specific body regions were positively associated with increased numbers of CT examinations.ConclusionWe observed a positive association between regional deprivation and CT numbers in non-cancer pediatric patients. Limitations of the ecological approach and the lack of differentiation of CT details have to be acknowledged. More information on CT indications is necessary for a full assessment of this finding. In addition, further work on ways to assess socio-economic status more accurately may be required.

Highlights

Ionizing radiation is associated with cancer, with risks increasing with higher doses and at younger ages at exposure [1]
Increasing numbers of computed tomography (CT) examinations in non-cancer patients were significantly associated with higher regional deprivation, which increased, CI overlap, for higher CT categories: ‘2–3 CT’ odds ratio (OR) = 1.45, 95%CI: 1.40–1.50; ‘4–5 CT’ OR = 1.48, 95%CI: 1.38–1.59; ‘6+CT’ OR = 1.54, 95%CI: 1.41–1.69
We observed a positive association between regional deprivation and CT numbers in noncancer pediatric patients

Summary

Introduction

Ionizing radiation is associated with cancer, with risks increasing with higher doses and at younger ages at exposure [1]. CT scans, use substantially higher doses of ionizing radiation compared to conventional x-ray examinations, while diagnostic approaches such as ultrasound or magnetic resonance imaging (MRI) provide alternative diagnostic approaches not using ionizing radiation [2] The use of these procedures has been steadily increasing worldwide for the past decades [3, 4]. In Germany, CT examination rates increased from 0.08 to 0.12 examinations per individual on average annually between 1996 and 2010, while numbers of conventional x-ray examinations declined at the same time [5] These comparatively higher radiation doses are assumed to potentially increase children’s risk for cancer, as children are known to be more radiation sensitive and have a longer lifespan after first exposure to potentially develop malignancies [1].

Methods

Results

Conclusion