Abstract
BackgroundIncreasing laboratory test utilization is a major challenge facing clinical laboratories.However, in most instances we lack population level information on the patient groups to which increased testing is directed. Much recent work has been published on the sociodemographic correlates of 25-hydroxyvitamin D deficiency. An unanswered question, however, is whether testing is preferentially directed towards individuals with a higher likelihood of deficiency. In this paper we examine this question by combining laboratory information system data on testing rates with Census Canada data.MethodsWe examined 1,436 census dissemination areas within the city of Calgary, Alberta, Canada. For each census dissemination area we determined age and sex-specific 25-hydroxyvitamin D testing rates over a one year period. We then compared these testing rates with the following sociodemographic variables obtained from Census Canada: first nations status, education level, household income, visible minority status, and recent immigrant status.ResultsOverall, 6.9% of males in the city of Calgary were tested during the study period. Females were 1.7 times more likely to be tested than males. Testing rate increased with increasing age, with 16.8% of individuals 66 years and over tested during the one-year study period.Individuals having at least some university education were less likely to be tested (RR = 0.60;p < 0.0001). Interestingly, although visible minorities were over twice as likely to be tested as compared to non-visual minorities (RR = 2.25; p < 0.0001), recent immigrants, a group known to exhibit low 25 hydroxyvitamin D levels, were significantly less likely to be tested than non-recent immigrants (RR = 0.72; p = 0.0174). While median household income was modestly associated with increased testing (RR = 1.02; p < 0.0001), First Nations status and non-English speaking were not significant predictors of 25-hydroxyvitamin D testing.ConclusionsTesting for 25-hydroxyvitamin D is in part directed toward populations at higher risk of deficiency (visible minorities) and at higher risk of osteoporosis (older females), but a particularly high risk group (recent immigrants) is being tested at a lower rate than other patient groups.
Highlights
Increasing laboratory test utilization is a major challenge facing clinical laboratories
In this paper we examine recent testing rates among Census Dissemination Areas in Calgary, Alberta to determine which sociodemographic factors are associated with greater testing rates
Data sources We first sought to determine the number of patients of each age and sex group in each census dissemination area who had at least one 25-hydroxyvitamin D test during the study period. 25-hydroxyvitamin D test data were obtained from the Laboratory Information System of Calgary Laboratory Services, the sole provider of laboratory testing for Calgary, Alberta and surrounding areas. 25-hydroxyvitamin D results were included for the period of 11 May 2010 and 10 May 2011
Summary
Increasing laboratory test utilization is a major challenge facing clinical laboratories. Increasing test utilization is one of the major challenges facing laboratories in the 21st century [1], and is compounded by the fact that between 10% and 50% of these laboratory tests may be unnecessary [2]. It is not surprising, that utilization management has become a major area of interest to laboratories throughout the western world [3,4,5]. In this paper we examine recent testing rates among Census Dissemination Areas in Calgary, Alberta to determine which sociodemographic factors are associated with greater testing rates. It is hoped that a comparison of these relative testing rates with known correlates of low 25-hydroxyvitamin D level will shed light on the appropriateness of current testing effort
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