Black or Hispanic kids receive less medical imaging than white kids

January 29, 2021

PITTSBURGH, Jan. 29, 2021 - A study led by UPMC Children's Hospital of Pittsburgh and the University of Pittsburgh School of Medicine shows that Black children are 18% less likely to get imaging tests as part of their emergency department visit compared to White children. Hispanic children are 13% less likely to have imaging done than Whites.

The researchers suggest that this disparity results from overuse in White children, though underuse in minority children probably plays a part as well. The root cause likely stems from both patient preferences and implicit bias among providers.

"Something else is going on here that's beyond the clinical, that's beyond the diagnoses," said study lead author Jennifer Marin, M.D., M.Sc., associate professor of pediatrics, emergency medicine and radiology at Pitt, and medical director of point-of-care ultrasound at UPMC Children's Hospital. "Cultural factors that come with people's race, gender, religion, etc., should not be associated with testing when getting that test is clearly not beneficial to the patient and potentially harmful."

The study, published today in JAMA Network Open, used pediatric emergency department billing data from 52 hospitals across 27 states plus the District of Columbia from 2016 to 2019 to measure racial disparities across all types of diagnostic imaging. This is the largest, broadest study of its kind to date.

Even after controlling for confounding factors, such as health insurance, diagnosis and household income, the data showed that doctors were ordering significantly fewer imaging tests for Black and Hispanic children than for White children. The effect was even stronger among patients who weren't admitted to the hospital--suggesting they weren't severely injured or sick.

While the data cannot distinguish between a test that was warranted and a test that wasn't, prior research has shown examples of more frequent imaging in White children compared to other races, with no differences in clinical outcomes. The researchers suspect that the differences they see in testing are largely driven by unnecessary testing among Whites.

That's a concern because some forms of imaging, specifically CT scans and X-rays, expose children to radiation, which likely increases their cancer risk.

"An unnecessary CT at five years old is not the same as an unnecessary CT at 70 years old," Marin said. "If you think of it in terms of lifetime risk, a five-year-old has 80-ish years to go on and develop malignancy, versus a 70-year-old who only has 15 years."

False positives and waste in medical spending also are concerning when tests are being ordered unnecessarily.

"We may get an image and the radiologist may see something--and that something may not be of clinical significance--then the child has to be subjected to downstream testing and monitoring," Marin said. "That's an added burden and stress on the family and added cost on the health care system."
Additional authors on the study include Jonathan Rodean, M.P.P., and Matt Hall, Ph.D., of Children's Hospital Association; Elizabeth Alpern, M.D., M.S.C.E., of Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine; Paul Aronson, M.D., M.H.S., of Yale School of Medicine; Pradip Chaudhari, M.D., of Children's Hospital Los Angeles and Keck School of Medicine of the USC; Eyal Cohen, M.D., M.Sc., of the Hospital for Sick Children; Stephen Freedman, M.D.C.M., M.Sc., of Alberta Children's Hospital; Rustin Morse, M.D., M.M.M., of Nationwide Children's Hospital; Alon Peltz, M.D., M.B.A., of Harvard Medical School; Margaret Samuels-Kalow, M.D., M.Phil., M.S.H.P., of Massachusetts General Hospital; Samir Shah, M.D., M.S.C.E., of Cincinnati Children's Hospital Medical Center; Harold Simon, M.D., M.B.A., of Emory University School of Medicine; and Mark Neuman, M.D., M.P.H., of Boston Children's Hospital and Harvard Medical School.

Additional Contact:
Andrea Kunicky
Mobile: 412-552-7448

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About UPMC Children's Hospital of Pittsburgh

Regionally, nationally, and globally, UPMC Children's Hospital of Pittsburgh is a leader in the treatment of childhood conditions and diseases, a pioneer in the development of new and improved therapies, and a top educator of the next generation of pediatricians and pediatric subspecialists. With generous community support, UPMC Children's Hospital has fulfilled this mission since its founding in 1890. UPMC Children's is recognized consistently for its clinical, research, educational, and advocacy-related accomplishments, including ranking in the top 10 on the 2020-2021 U.S. News & World Report Honor Roll of America's Best Children's Hospitals. UPMC Children's also ranks 15th among children's hospitals and schools of medicine in funding for pediatric research provided by the National Institutes of Health (FY2019).

About the University of Pittsburgh School of Medicine

As one of the nation's leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1998. In rankings recently released by the National Science Foundation, Pitt ranked fifth among all American universities in total federal science and engineering research and development support.

Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region's economy. For more information about the School of Medicine, see

University of Pittsburgh

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