Health Equity for Radiology

Disclosure:

I serve as the Radiology Health Equity Coalition (RHEC) liaison for the APDR and ARRS.

Why should we be interested in Health Equity?
Some have written about the "Business Case for Health Equity"

https://www2.deloitte.com/us/en/blog/health-care-blog/2022/the-business-case-for-health-equity-in-life-sciences.html

https://coverage.bluecrossma.com/article/making-business-case-health-equity

https://newsroom.thecignagroup.com/buisness-case-for-health-equity-ey-research

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907942/

https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0154

Our 10AM session at ARRS 2023 " Practical Health Equity" April 16, 2023 is now on youtube!

https://www.youtube.com/watch?v=0jtPOWufzaU

Te program:

5m Welcome- Nolan Kagetsu

15m Introduction to Health Equity- Nolan Kagetsu

15m Barriers to Care- Dan Chonde (ARRS DEI Subcommittee Chair)

15m Climate change and Health Equity- Julia Schoen

15m Practical steps to improve health equity -- low hanging fruit- Stephen Waite

15m Gender Disparity in Patients and Clinical Trials- Faisal Khosa

15m First steps toward Health Equity- Efren Flores

20m Moderated Q/A Nolan Kagetsu

There are many facets to health Equity:

Screening

Institutions can be incentivized to get their "covered lives" appropriate screening

Sustainability

Climate change disproportionately affect poor countries/communities

International

e.g. work with groups like Rad-AID (president Daniel Mollura, MD)

https://rad-aid.org/

They have a national meeting in D.C, this year on Nov 4, 2023

https://twitter.com/RADAIDIntl/status/1678885432811978754?s=20

Many workflow issues intersect with health equity

e.g. same day studies can reduce the likelyhood of a patient not keeping their appointment ("no show")

Some institutions subsidize travel for imaging appointments.

Training

Trainee supervision should be the same regardless of the patient's insurance status

Patient Experience

Limited English Proficiency (LEP)

9 % total population

Hispanic 63%

Asian 20-30%

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252148/

translation services

get staff/ trainees to be interpreters (verbal) or translators (written)

give trainees financial support time to get training per local regs

Joint Commission Mandate

Radiology should contribute to their hospitals health equity efforts.

Some discussion topics from https://www.radhealthequity.org/About-Us#who

Excess/potentially preventable deaths from cancer, lower respiratory disease and other illnesses in rural areas are often nearly double that of urban areas.
- Life expectancy is three years shorter, and heart disease, cancer and stroke death rates are significantly higher in rural areas (23% of the U.S. population) vs. metropolitan areas.
- 22% of those in rural areas live within 30 minutes of a lung cancer screening center vs. 83% in urban areas.
Black women are 42% more likely to die from breast cancer than white women.
Black men are 52% more likely to die from colorectal cancer (CRC) than white men. The 19% CRC disparity may be due to fewer screenings.
Black Americans with diabetes are three times more likely to have a limb amputated than others.
U.S. Latinos are more likely to die from CRC than those in many Central and South American nations. The CRC death rate for U.S. Latinos has dropped more slowly than for whites.
Asian Americans are twice as likely to die from stomach cancers, eight times more likely to die from hepatitis and have a tuberculosis rate more than 30 times higher than white Americans.

join RHEC (free)

take the pledge https://www.radhealthequity.org/

GFR "correction"

https://reports.mountsinai.org/article/neph2021-07-egfr-and-race

Lung Cancer Screening

NSCLC is more prevalent in Asians, yet there are no screening guidelines (insurance reimbursement) for screening CT for those who never smoked (LCINS)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777900/

Advocate for low cost screening for those not covered by insurance!

NYU is doing research in this area:

https://med.nyu.edu/departments-institutes/perlmutter-cancer-center/cancer-research/disease-management-groups/thoracic-oncology-research/new-york-female-asian-nonsmoker-screening-study

As presented at #RSNA22

Black women are 40% more likely than white women to die from breast cancer, even though the cancer incidence rate among Black and white women is approximately the same. Black women had less access to new mammography technology compared with white women, even when getting their mammograms at the same institution

https://www.rsna.org/news/2022/october/Mammography-Access-Disparities

https://pubs.rsna.org/doi/10.1148/radiol.221153

Action Items

Learn about the UN SDGs

https://sdgs.un.org/goals

Join the AAWR (SDG goal 5)

https://www.aawr.org/

Join the RHEC

https://www.radhealthequity.org/

Join NMA SRRO

https://www.nmarads.org/

References: