Patient Factor Disparities in Imaging Follow-Up Rates After Incidental Abdominal Findings

The effect of demographics and societal determinants on imaging follow-up rates is not clear. The purpose of this study was to compare characteristics of patients with imaging findings representing possible cancer who undergo follow-up imaging versus those who do not to better understand factors that contribute to follow-up completion.

The records of 1588 patients with indeterminate abdominal imaging findings consecutively registered between July 1, 2013, and March 20, 2014, were reviewed. Several patient characteristics, including distance between patients' home zip codes and the flagship hospital of the health system were compared between the groups who did and did not undergo follow-up imaging. Subgroup analyses based on the location of the index examination were also performed.

Among the 1513 (36.62%) included patients, 554 did not undergo follow-up abdominal imaging within 1 year of the index examination. The same was true of 270 of 938 (28.78%) outpatients and 168 of 279 (60.21%) emergency department patients. Eighty-nine of 959 (9.28%) patients who underwent follow-up imaging were younger than 40 years, compared with 76 of 554 (13.72%) patients who did not undergo follow-up imaging (p = 0.005). Fifty-four of 959 (5.63%) patients who underwent follow-up imaging were older than 80 years, compared with 70 of 554 (12.64%) patients who did not undergo follow-up imaging (p < 0.001). More white patients (587 of 959 vs 301 of 554, p = 0.007) and fewer black patients (204 of 554 versus 270 of 959, p < 0.001) were found in the follow-up imaging group. Greater distance from the flagship hospital correlated with less follow-up in the outpatient subgroup only (p = 0.03).

Emergency department patients and patients at the extremes of age are less likely to complete follow-up imaging. Insurance status and race and ethnicity may affect follow-up completion rates. The relationship between distance to hospital and follow-up completion requires further investigation.