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Racial referral bias in cardiac computed tomography: Differences, disparities or discrimination?
Benjamin J W Chow1, Saad Balamane2, Anahita Tavoosi2
1University of Ottawa Heart Institute, Department of Medicine (Cardiology), Canada; University of Ottawa, Department of Radiology, Canada.
Insights
Racial disparities in Cardiac CT (CCT) referrals were observed, with White patients referred at a higher rate than non-White patients. These referral patterns were independent of physician race or experience, highlighting a need to address systemic biases in diagnostic testing.
Area of Science:
- Cardiology
- Medical Imaging
- Health Disparities Research
Background:
- Existing disparities in medical care can negatively impact patient outcomes.
- Understanding racial biases in diagnostic testing is crucial for equitable healthcare.
- Cardiac CT (CCT) utilization is an area where such disparities may manifest.
Purpose of the Study:
- To investigate racial disparities in diagnostic Cardiac CT (CCT) referrals.
- To identify potential influences of racial bias on CCT utilization.
- To analyze referral patterns in relation to patient and physician demographics.
Main Methods:
- Retrospective analysis of CCT referrals from February 2006 to November 2021.
- Inclusion of patient race, referring physician race, and catchment area population demographics.
- Indexing CCT referral frequency to the respective racial populations within the catchment area.
Main Results:
- White patients (82.5%) were disproportionately referred for CCT compared to their representation in the catchment population.
- Non-White racial groups exhibited lower CCT referral rates relative to their population size (Referral Index: Whites 1.2 vs. Non-Whites 0.6, p < 0.001).
- Observed racial referral disparities persisted across all minority groups and age categories, independent of physician race or years in practice.
Conclusions:
- Significant racial differences in Cardiac CT referral rates were identified.
- These disparities are not explained by disease prevalence, physician race, or physician experience.
- Further research is needed to understand the root causes of these disparities and develop strategies for bias mitigation.
Background:
Disparities exist in medicine and can affect patient care. We sought to understand influences of racial biases in diagnostic testing within a Cardiac CT (CCT) population.
Methods:
Race of CCT patients, referring physicians and the population in the catchment area were captured between February 2006 and November 2021. The frequency of CCT referrals for each race was indexed to the catchment population.
Results:
Of 21,241 CCT patients, 17,514 (82.5 %) patients were White. The Non-White population was comprised of 467(2.2 %) Indigenous, 656(3.1 %) Black, 932(4.4 %) Asian, 276(1.3 %) South Asian, 1100(5.2 %) Middle Eastern and 296(1.4 %) Latin American races. The catchment population was 907,675, with 619,514 individuals of whom 69.7 % identified as White. Compared to the catchment population, there was a disproportionately higher referral rate for Whites than Non-Whites. The referral index for Whites was higher than Non-Whites (1.2 versus 0.6, p < 0.001)). This pattern was consistent across all racial minorities and age categories. A total of 356 physicians (236(66.3 %) White, 4(1.2 %) Black, 39(12.0 %) Asian, 30(9.2 %) South Asian, 43(13.2 %), Middle Eastern and 4 (1.2 %) Latin American) made referrals to CCT. The racial difference in referral patterns was independent of physician race and was independent of their years in practice.
Conclusions:
Racial differences exist in CCT referrals. These differences are independent of prevalence of disease, physician race or years in practice. This study supports the need to better understand reasons for disparity and strategies to mitigate potential bias.
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