Neighborhood Socioeconomic Status and Distance From Home Address to Imaging Center Influence the Acuity of Brain MRI Findings.

Abstract

Lower socioeconomic status (SES) and longer distance to providers have been linked to disparities in health care access, often delaying diagnostic evaluation of acute conditions. Determining the effects of nonmedical factors on the acuity of MRI findings is critical for addressing health care inequities and improving access to medical imaging. The goal of this study was to characterize the effects of neighborhood SES and distance from home address to imaging center on acuity of brain MRI findings. The investigators evaluated brain MRI scans acquired from March 2019 to March 2020. Neighborhood SES was quantified using the area deprivation index (ADI), and acuity was categorized by board-certified neuroradiologists (1, 2, or 3, with 3 indicating the highest acuity). Distance between home address and imaging center was calculated in miles and log₂ transformed. The χ² test and analysis of variance were used to assess groupwise differences in acuity. A multinomial baseline-category logit model was used to assess the relationship between z-scored ADI and log distance on acuity, controlling for age, sex, race, marital status, insurance type, and encounter type. The final cohort consisted of brain MRI scans from 4,813 individuals (mean age, 58.5 ± 17.3 years; 2,733 women). Acuity varied significantly across sex, race, marital status, insurance type, encounter type, and imaging center. Regression analysis revealed a 1-SD increase in z-scored ADI (ie, lower neighborhood SES) resulted in significantly higher acuity of inpatient brain MRI scans (acuity 2 > 1 odds ratio [OR], 1.34 [P = .0016]; acuity 3 > 1 OR, 1.32 [P = .0012]) and emergency department scans (acuity 2 > 1 OR, 1.27; P = .045). A twofold increase in distance resulted in significantly higher acuity of brain MRI findings for all scans (acuity 2 > 1 OR, 1.07 [P = .026]; acuity 3 > 1 OR, 1.15 [P < .001]). Lower neighborhood SES for inpatient and emergency department scans and greater distance between home address and imaging center for all scans result in significantly higher odds of more acute brain MRI findings.