Abstract
Socio-economic factors affecting health care can lead to delays in diagnosis of neurological conditions, consequentially affecting treatment and morbidity rates. This inequality in health care can leave patients from lower socio-economic backgrounds more vulnerable to a poorer quality of care from health care providers in the United Kingdom (U.K.). Aims: In this systematic review, we assess the impact of socio-economic status on the use of diagnostic neuroimaging in the U.K., measured by the timeliness, accessibility and appropriate use of computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography, electroencephalography (EEG) and single-photon emission computed tomography (SPECT). We specifically evaluate the non-surgical use of neuroimaging techniques as this relies on the judgment of primary care-givers (e.g., doctors and radiologists), where health disparities are most common. This study includes the analysis of diagnostic imaging used for dementia, minor head injury, stroke, cancer, epilepsy, chronic inflammatory demyelinating polyneuropathy and Parkinson’s disease. With this study, we aim to assess the health inequalities at disease diagnosis. Methods: Using Medline (via Ovid), PubMed and Web of Science databases as sources of information, we critically appraise existing studies on neuroimaging use in the U.K. health care system, published between January 2010 and February 2021. Findings: A total of 18 studies were included in this research, revealing that there was an increase in patients of Black and Asian communities diagnosed with dementia and at an earlier age. There was little evidence to suggest that a lack of access to diagnostic imaging is associated with socio-economic status. However, there are data to suggest that people of a lower socio-economic background require more specialist services with diagnostic neuroimaging tools. In addition, there is evidence to suggest that diagnostic neuroimaging techniques could be utilised more effectively by health care workers to prevent unnecessary delays in diagnosis for patients in lower socio-economic areas.
Highlights
The aim of this study is to examine the characteristics of patients undergoing diagnostic neuroimaging across the U.K., including race, socio-economic status and disease severity, to determine whether there is a significant inequality in access to the required neuroimaging technology
Studies that did not use structural or functional imaging techniques, studies exploring inequalities in mental health care or pharmacotherapy, studies using animal models and ineligible study designs were excluded after review
-Vascular dementia is more common in black patients
Summary
Neurological conditions can progress rapidly, so an early diagnosis is vital for treatment and survival. It is recognised by the National Health Service (NHS) that delays in primary and secondary care can lead to a delayed diagnosis, which could have major consequences for treatment and morbidity rates [1]. The knowledge and awareness surrounding health inequalities have increased. The complex dynamics of the social determinants has an effect on the timeliness of diagnosis and, disease progression [2,3]. In the more diverse and aging population, people are living longer and
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