Semin intervent Radiol 2023; 40(05): 427-436
DOI: 10.1055/s-0043-1775878
Review Article

A Review of Healthcare Disparities Relevant to Interventional Radiology

Katherine Marchak
1   Division of Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
,
Davinder Singh
2   Division of Diagnostic Radiology/Department of Radiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Mira Malavia
3   University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
,
Premal Trivedi
1   Division of Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
› Author Affiliations

Abstract

Racial, ethnic, and gender disparities have received focused attention recently, as they became more visible in the COVID era. We continue to learn more about how healthcare disparities manifest for our patients and, more broadly, the structural underpinnings that result in predictable outcomes gaps. This review summarizes what we know about disparities relevant to interventional radiologists. The prevalence and magnitude of disparities are quantified and discussed where relevant. Specific examples are provided to demonstrate how factors like gender, ethnicity, social status, geography, etc. interact to create inequities in the delivery of interventional radiology (IR) care. Understanding and addressing health disparities in IR is crucial for improving real-world patient outcomes and reducing the economic burden associated with ineffective and low-value care. Finally, the importance of intentional mentorship, outreach, education, and equitable distribution of high-quality healthcare to mitigate these disparities and promote health equity in interventional radiology is discussed.

Disclosures

K. M.: None.


D.S.: None.


M.M.: None.


P.T.: Consultant—Boston Scientific, speaking and consulting fees—Fortec Medical, advisory board—Pneumonix. Grant support from the National Heart, Lung and Blood Institute, National Cancer Institute, and American Heart Association unrelated to the current submission.




Publication History

Article published online:
02 November 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Ndugga N, Artiga S. Disparities in Health and Health Care: 5 Key Questions and Answers. KFF. April 21, 2023. Accessed June 15, 2023 at: https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers
  • 2 Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Accessed June 15, 2023 at: https://health.gov/healthypeople/objectives-and-data/social-determinants-health
  • 3 Impact of Racism. Centers for Disease Control and Prevention. Updated April 8, 2021 . Accessed June 15, 2023 at: https://www.cdc.gov/minorityhealth/racism-disparities/impact-of-racism.html
  • 4 Singh R. Key Facts on Health and Health Care by Race and Ethnicity. KFF. January 26, 2022 . Accessed June 15, 2023 at: https://www.kff.org/racial-equity-and-health-policy/press-release/key-facts-on-health-and-health-care-by-race-and-ethnicity/
  • 5 LaVeist TA, Pérez-Stable EJ, Richard P. et al. The economic burden of racial, ethnic, and educational health inequities in the US. JAMA 2023; 329 (19) 1682-1692
  • 6 Physician Specialty Data Report. Association of American Medical Colleges. Accessed August 28, 2023 at: https://www.aamc.org/data-reports/workforce/data/active-physicians-sex-specialty-2021
  • 7 Deipolyi AR, Becker AS, Covey AM. et al. Gender disparity in industry relationships with academic interventional radiology physicians. AJR Am J Roentgenol 2020; 215 (02) 494-501
  • 8 Higgins MCSS, Sun YL, Rochon PJ. Workforce diversity of interventional radiology physicians in North America: reflections on the U.S. experience. Can Assoc Radiol J 2023; 74 (01) 192-201
  • 9 Kim J, Kaylor K, Lamparello N. The gender gap in interventional radiology: barriers, opportunities, and the role of the integrated IR residency. Acad Radiol 2023; DOI: 10.1016/j.acra.2023.01.008.
  • 10 Jaschke W, Bartal G, Trianni A, Belli AM. Fighting the gender gap in interventional radiology: facts and fiction relating to radiation. Cardiovasc Intervent Radiol 2018; 41 (08) 1254-1256
  • 11 Matsumoto MM, Tullius Jr TG, Navuluri R. Gender-specific factors influencing medical students' career choice of IR. J Vasc Interv Radiol 2019; 30 (09) 1432-1437
  • 12 Egleston BL, Dunbrack Jr RL, Hall MJ. Clinical trials that explicitly exclude gay and lesbian patients. N Engl J Med 2010; 362 (11) 1054-1055
  • 13 Wandy T, Gray S, Durand DJ, Kadom N. Improving awareness of LGBTQ patient preferences among radiology staff members. Curr Probl Diagn Radiol 2021; 50 (06) 768-771
  • 14 Crissman HP, Berger MB, Graham LF, Dalton VK. Transgender demographics: a household probability sample of US adults, 2014. Am J Public Health 2017; 107 (02) 213-215
  • 15 Gates GJ. How many people are lesbian, gay, bisexual, and transgender? Los Angeles: The Williams Institute. 2011 . Accessed June 16, 2023 at: https://williamsinstitute.%20law.ucla.edu/wp-content/uploads/Gates-How-Many-People-LGBT-Apr-2011.%20pdf
  • 16 Winter S, Diamond M, Green J. et al. Transgender people: health at the margins of society. Lancet 2016; 388 (10042): 390-400
  • 17 Grant JM, Mottet LA, Tanis J. et al. Injustice at every turn: a report of the National Transgender Discrimination Survey. National Center for Transgender Equality and National Gay and Lesbian Task Force,. Washington, DC; 2011. Accessed July 9, 2023 at: https://www.hivlawandpolicy.org/sites/default/files/Injustice%20at%20Every%20Turn.pdf
  • 18 James SE, Herman JL, Rankin S. et al. The Report of the 2015 U.S. Transgender Survey. National Center for Transgender Equality,. Washington, DC; 2016. Accessed July 9, 2023 at: https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf
  • 19 Neira PM. Caring for the transgender patient. J Radiol Nurs 2017; 36: 88-89
  • 20 Grossman VG. Providing quality care to the transgender patient in the radiology setting. J Radiol Nurs 2016; 35 (03) 218-226
  • 21 Mueller PR, Biswal S, Halpern EF, Kaufman JA, Lee MJ. Interventional radiologic procedures: patient anxiety, perception of pain, understanding of procedure, and satisfaction with medication – a prospective study. Radiology 2000; 215 (03) 684-688
  • 22 Goldhaber SZ, Bounameaux H. Pulmonary embolism and deep vein thrombosis. Lancet 2012; 379 (9828) 1835-1846
  • 23 Martin KA, McCabe ME, Feinglass J, Khan SS. Racial disparities exist across age groups in Illinois for pulmonary embolism hospitalizations. Arterioscler Thromb Vasc Biol 2020; 40 (09) 2338-2340
  • 24 Barco S, Valerio L, Ageno W. et al. Age-sex specific pulmonary embolism-related mortality in the USA and Canada, 2000-18: an analysis of the WHO mortality database and of the CDC multiple cause of death database. Lancet Respir Med 2021; 9 (01) 33-42
  • 25 Abi-Jaoudeh N, Ahmed K, Breuer J. Disparities in IR care for pulmonary embolism. Endovascular Today. 2022; 21 (09) 31-32
  • 26 Phillips AR, Reitz KM, Myers S. et al. Association between black race, clinical severity, and management of acute pulmonary embolism: a retrospective cohort study. J Am Heart Assoc 2021; 10 (17) e021818
  • 27 Agarwal MA, Dhaliwal JS, Yang EH. et al. Sex differences in outcomes of percutaneous pulmonary artery thrombectomy in patients with pulmonary embolism. Chest 2023; 163 (01) 216-225
  • 28 Shahjehan RD, Bhutta BS. et al. Coronary Artery Disease [Updated February 9, 2023]. Treasure Island, FL: StatPearls Publishing; 2023. . Accessed June 16, 2023 at: https://www.ncbi.nlm.nih.gov/books/NBK564304/
  • 29 Conigliaro J, Whittle J, Good CB. et al. Understanding racial variation in the use of coronary revascularization procedures: the role of clinical factors. Arch Intern Med 2000; 160 (09) 1329-1335
  • 30 Whittle J, Conigliaro J, Good CB, Lofgren RP. Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system. N Engl J Med 1993; 329 (09) 621-627
  • 31 Khaku AS, Tadi P. Cerebrovascular Disease. [Updated 2022 Aug 8]. Treasure Island, FL: StatPearls Publishing;; 2023. . Accessed June 16, 2023 at: https://www.ncbi.nlm.nih.gov/books/NBK430927/
  • 32 Cruz-Flores S, Rabinstein A, Biller J. et al; American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, Council on Quality of Care and Outcomes Research. Racial-ethnic disparities in stroke care: the American experience: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42 (07) 2091-2116
  • 33 Kapral MK, Fang J, Hill MD. et al; Investigators of the Registry of the Canadian Stroke Network. Sex differences in stroke care and outcomes: results from the Registry of the Canadian Stroke Network. Stroke 2005; 36 (04) 809-814
  • 34 Dougu N, Takashima S, Sasahara E. et al. Predictors of poor outcome in patients with acute cerebral infarction. J Clin Neurol 2011; 7 (04) 197-202
  • 35 Di Carlo A, Lamassa M, Baldereschi M. et al; European BIOMED Study of Stroke Care Group. Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry. Stroke 2003; 34 (05) 1114-1119
  • 36 Eriksson M, Carlberg B, Eliasson M. The disparity in long-term survival after a first stroke in patients with and without diabetes persists: the Northern Sweden MONICA study. Cerebrovasc Dis 2012; 34 (02) 153-160
  • 37 Otite FO, Saini V, Sur NB. et al. Ten-year trend in age, sex, and racial disparity in tPA (Alteplase) and thrombectomy use following stroke in the United States. Stroke 2021; 52 (08) 2562-2570
  • 38 Hicks CW, Daya NR, Black III JH, Matsushita K, Selvin E. Race and sex-based disparities associated with carotid endarterectomy in the Atherosclerosis Risk in Communities (ARIC) study. Atherosclerosis 2020; 292: 10-16
  • 39 Wise ES, Ladner TR, Song J. et al. Race as a predictor of delay from diagnosis to endarterectomy in clinically significant carotid stenosis. J Vasc Surg 2015; 62 (01) 49-56
  • 40 Saran R, Robinson B, Abbott KC. et al. US Renal Data System 2017 Annual Data Report: epidemiology of kidney disease in the United States. Am J Kidney Dis 2018; 71 (3, Suppl 1): A7 [published correction appears in Am J Kidney Dis. 2018;71(4):501]
  • 41 Norris KC, Williams SF, Rhee CM. et al. Hemodialysis disparities in African Americans: the deeply integrated concept of race in the social fabric of our society. Semin Dial 2017; 30 (03) 213-223
  • 42 McDonnell SM, Frueh J, Blecha M, Aulivola B, Halandras PM. Health care disparities involved in establishing functional arteriovenous fistula hemodialysis access. J Vasc Surg 2023; 78 (03) 774-778
  • 43 Trivedi PS, Lind KE, Ray CE, Rochon PJ, Ryu RK. Race and sex disparities in outcomes of dialysis access maintenance interventions. J Vasc Interv Radiol 2018; 29 (04) 476-481.e1
  • 44 Ferlay J, Soerjomataram I, Dikshit R. et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136 (05) E359-E386
  • 45 Jemal A, Ward EM, Johnson CJ. et al. Annual report to the nation on the status of cancer, 1975-2014, featuring survival. J Natl Cancer Inst 2017; 109 (09) djx030
  • 46 Singal AG, Pillai A, Tiro J. Early detection, curative treatment, and survival rates for hepatocellular carcinoma surveillance in patients with cirrhosis: a meta-analysis. PLoS Med 2014; 11 (04) e1001624
  • 47 Singal AG, Li X, Tiro J. et al. Racial, social, and clinical determinants of hepatocellular carcinoma surveillance. Am J Med 2015; 128 (01) 90.e1-9 -0.e7
  • 48 Davila JA, El-Serag HB. Racial differences in survival of hepatocellular carcinoma in the United States: a population-based study. Clin Gastroenterol Hepatol 2006; 4 (01) 104-110 , quiz 4–5
  • 49 Flores YN, Datta GD, Yang L. et al. Disparities in hepatocellular carcinoma incidence, stage, and survival: a large population-based study. Cancer Epidemiol Biomarkers Prev 2021; 30 (06) 1193-1199
  • 50 Mathur AK, Osborne NH, Lynch RJ, Ghaferi AA, Dimick JB, Sonnenday CJ. Racial/ethnic disparities in access to care and survival for patients with early-stage hepatocellular carcinoma. Arch Surg 2010; 145 (12) 1158-1163
  • 51 Ha J, Chaudhri A, Avirineni A, Pan JJ. Burden of hepatocellular carcinoma among Hispanics in South Texas: a systematic review. Biomark Res 2017; 5: 15
  • 52 Garg T, Gong AJ, Khalil A. et al. Racial and ethnic disparities among participants in hepatocellular carcinoma clinical studies evaluating transarterial therapies. J Vasc Interv Radiol 2023; 34 (01) 4-10.e3
  • 53 Amesur NB, Novelli P. Transjugular Intrahepatic Portosystemic Shunt. [Updated 2022 Jul 25]. Treasure Island, FL:: StatPearls Publishing; 2023. . Accessed June 17, 2023 at: https://www.ncbi.nlm.nih.gov/books/NBK513268/
  • 54 Nguyen GC, Segev DL, Thuluvath PJ. Racial disparities in the management of hospitalized patients with cirrhosis and complications of portal hypertension: a national study. Hepatology 2007; 45 (05) 1282-1289
  • 55 Trivedi PS, Rochon PJ, Durham JD, Ryu RK. National trends and outcomes of transjugular intrahepatic portosystemic shunt creation using the nationwide inpatient sample. J Vasc Interv Radiol 2016; 27 (06) 838-845
  • 56 Henderson JM, Boyer TD, Kutner MH. et al; DIVERT Study Group. Distal splenorenal shunt versus transjugular intrahepatic portal systematic shunt for variceal bleeding: a randomized trial. Gastroenterology 2006; 130 (06) 1643-1651
  • 57 DeYoung E, Minocha J. Inferior vena cava filters: guidelines, best practice, and expanding indications. Semin Intervent Radiol 2016; 33 (02) 65-70
  • 58 Molvar C. Inferior vena cava filtration in the management of venous thromboembolism: filtering the data. Semin Intervent Radiol 2012; 29 (03) 204-217
  • 59 Decousus H, Leizorovicz A, Parent F. et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med 1998; 338 (07) 409-415
  • 60 Edwards MA, Mazzei M, Zhao H, Reddy S, Bashir R. Racial disparities in inferior vena cava filter use in metabolic and bariatric surgery patients: nationwide insights from the MBSAQIP database. Am J Surg 2021; 221 (04) 749-758
  • 61 Sridharan N, Williams AO, Rojanasarot S. et al. Cost burden and cost influencers of inferior vena cava filter placement and retrieval among Medicare beneficiaries with acute venous thromboembolism. J Vasc Interv Radiol 2023; 34 (02) 164-172.e2
  • 62 Williams AO, Sridharan N, Rojanasarot S. et al. Population-based disparities in inferior vena cava filter procedures among Medicare enrollees with acute venous thromboembolism. J Am Coll Radiol 2022; 19 (06) 722-732
  • 63 Patel S, Chiu RG, Chaker AN. et al. Current trends and socioeconomic disparities in the utilization of spine augmentation for patients with osteoporotic vertebral compression fracture: a nationwide inpatient sample analysis from 2012 to 2016. Int J Spine Surg 2022; 16 (03) 490-497
  • 64 Wright NC, Looker AC, Saag KG. et al. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res 2014; 29 (11) 2520-2526
  • 65 Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH. Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med 2002; 162 (19) 2217-2222
  • 66 Birkmeyer NJ, Weinstein JN, Tosteson AN. et al. Design of the Spine Patient outcomes Research Trial (SPORT). Spine 2002; 27 (12) 1361-1372
  • 67 Tamayo-Sarver JH, Dawson NV, Hinze SW. et al. The effect of race/ethnicity and desirable social characteristics on physicians' decisions to prescribe opioid analgesics. Acad Emerg Med 2003; 10 (11) 1239-1248
  • 68 Cydulka RK, Tamayo-Sarver J, Gage A, Bagnoli D. Association of patient satisfaction with complaints and risk management among emergency physicians. J Emerg Med 2011; 41 (04) 405-411
  • 69 Heins JK, Heins A, Grammas M, Costello M, Huang K, Mishra S. Disparities in analgesia and opioid prescribing practices for patients with musculoskeletal pain in the emergency department. J Emerg Nurs 2006; 32 (03) 219-224
  • 70 Pletcher MJ, Kertesz SG, Kohn MA, Gonzales R. Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA 2008; 299 (01) 70-78
  • 71 Adogwa O, Elsamadicy AA, Mehta AI, Cheng J, Bagley CA, Karikari IO. Racial disparities in 30-day readmission rates after elective spine surgery: a single institutional experience. Spine 2016; 41 (21) 1677-1682
  • 72 Fereydooni A, Patel J, Dossabhoy SS, George EL, Arya S. Racial, ethnic, and socioeconomic inequities in amputation risk for patients with peripheral artery disease and diabetes. Semin Vasc Surg 2023; 36 (01) 9-18
  • 73 Saxon JT, Safley DM, Mena-Hurtado C. et al. Adherence to guideline-recommended therapy-including supervised exercise therapy referral-across peripheral artery disease specialty clinics: insights from the International PORTRAIT Registry. J Am Heart Assoc 2020; 9 (03) e012541
  • 74 Mota L, Marcaccio CL, Zhu M. et al. Impact of neighborhood social disadvantage on the presentation and management of peripheral artery disease. J Vasc Surg 2023; 77 (05) 1477-1485
  • 75 Williams DR, Lawrence JA, Davis BA. Racism and health: evidence and needed research. Annu Rev Public Health 2019; 40: 105-125
  • 76 Fanaroff AC, Yang L, Nathan AS. et al. Geographic and socioeconomic disparities in major lower extremity amputation rates in metropolitan areas. J Am Heart Assoc 2021; 10 (17) e021456
  • 77 Vemulapalli S, Greiner MA, Jones WS, Patel MR, Hernandez AF, Curtis LH. Peripheral arterial testing before lower extremity amputation among Medicare beneficiaries, 2000 to 2010. Circ Cardiovasc Qual Outcomes 2014; 7 (01) 142-150
  • 78 Henry AJ, Hevelone ND, Belkin M, Nguyen LL. Socioeconomic and hospital-related predictors of amputation for critical limb ischemia. J Vasc Surg 2011; 53 (02) 330-9.e1
  • 79 Holman KH, Henke PK, Dimick JB, Birkmeyer JD. Racial disparities in the use of revascularization before leg amputation in Medicare patients. J Vasc Surg 2011; 54 (02) 420-426 , 426.e1
  • 80 de Jager E, Gunnarsson R, Ho YH. Disparities in advanced peripheral arterial disease presentation by socioeconomic status. World J Surg 2022; 46 (06) 1500-1507
  • 81 Arhuidese I, Wang S, Locham S, Faateh M, Nejim B, Malas M. Racial disparities after infrainguinal bypass surgery in hemodialysis patients. J Vasc Surg 2017; 66 (04) 1163-1174
  • 82 Selvarajah S, Black III JH, Haider AH, Abularrage CJ. Racial disparity in early graft failure after infrainguinal bypass. J Surg Res 2014; 190 (01) 335-343
  • 83 Singh N, Sidawy AN, DeZee KJ, Neville RF, Akbari C, Henderson W. Factors associated with early failure of infrainguinal lower extremity arterial bypass. J Vasc Surg 2008; 47 (03) 556-561
  • 84 Garfield K, LaGrange CA. Renal Cell Cancer. [Updated 2022 Aug 1]. Treasure Island, FL: StatPearls Publishing; 2023. . Accessed July 8, 2023 at: https://www.ncbi.nlm.nih.gov/books/NBK470336/
  • 85 Lipworth L, Tarone RE, McLaughlin JK. Renal cell cancer among African Americans: an epidemiologic review. BMC Cancer 2011; 11: 133
  • 86 Joshi SS, Handorf EA, Zibelman M. et al. Treatment facility volume and survival in patients with metastatic renal cell carcinoma: a registry-based analysis. Eur Urol 2018; 74 (03) 387-393
  • 87 Jonasch E. Updates to the management of kidney cancer. J Natl Compr Canc Netw 2018; 16 (5S): 639-641
  • 88 Talenfeld AD, Gennarelli RL, Elkin EB. et al. Percutaneous ablation versus partial and radical nephrectomy for T1a renal cancer: a population-based analysis. Ann Intern Med 2018; 169 (02) 69-77
  • 89 Berndt SI, Carter HB, Schoenberg MP, Newschaffer CJ. Disparities in treatment and outcome for renal cell cancer among older black and white patients. J Clin Oncol 2007; 25 (24) 3589-3595
  • 90 Chow WH, Devesa SS, Warren JL, Fraumeni Jr JF. Rising incidence of renal cell cancer in the United States. JAMA 1999; 281 (17) 1628-1631
  • 91 Rhodes JM, Gloviczki P, Canton LG, Rooke T, Lewis BD, Lindsey JR. Factors affecting clinical outcome following endoscopic perforator vein ablation. Am J Surg 1998; 176 (02) 162-167
  • 92 Brand FN, Dannenberg AL, Abbott RD, Kannel WB. The epidemiology of varicose veins: the Framingham Study. Am J Prev Med 1988; 4 (02) 96-101
  • 93 Kahle B, Leng K. Efficacy of sclerotherapy in varicose veins – prospective, blinded, placebo-controlled study. Dermatol Surg 2004; 30 (05) 723-728 , discussion 728
  • 94 Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux: long-term results. J Vasc Interv Radiol 2003; 14 (08) 991-996
  • 95 Dua A, Desai SS, Heller JA. The impact of race on advanced chronic venous insufficiency. Ann Vasc Surg 2016; 34: 152-156
  • 96 Cho LD, Bai H, Collins LC. et al. Race differences in iliofemoral vein stenting for chronic venous insufficiency. Vascular 2022; 170 85381221140612 DOI: 10.1177/17085381221140612.
  • 97 Pappas PJ, Pappas SF, Nguyen KQ, Lakhanpal S. Racial disparities in the outcomes of superficial vein treatments for chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord 2020; 8 (05) 789-798.e3
  • 98 Singh GK. Area deprivation and widening inequalities in US mortality, 1969-1998. Am J Public Health 2003; 93 (07) 1137-1143
  • 99 Robinette JW, Charles ST, Gruenewald TL. Neighborhood socioeconomic status and health: a longitudinal analysis. J Community Health 2017; 42 (05) 865-871
  • 100 Bosma H, van de Mheen HD, Borsboom GJ, Mackenbach JP. Neighborhood socioeconomic status and all-cause mortality. Am J Epidemiol 2001; 153 (04) 363-371