title: The Impact of Socioeconomic Status on the Utilization of Spinal Imaging.
abstract: BACKGROUND
  Few studies have examined the general correlation between socioeconomic status and imaging. This study is the first to analyze this relationship in the spine patient population.
  
  
  OBJECTIVE
  To assess the effect of socioeconomic status on the frequency with which imaging studies of the lumbar spine are ordered and completed.
  
  
  METHODS
  Patients that were diagnosed with lumbar radiculopathy and/or myelopathy and had at least 1 subsequent lumbar magnetic resonance imaging (MRI), computed tomography (CT), or X-ray ordered were retrospectively identified. Demographic information and the number of ordered and completed imaging studies were among the data collected. Patient insurance status and income level (estimated based on zip code) served as representations of socioeconomic status.
  
  
  RESULTS
  A total of 24,105 patients met the inclusion criteria for this study. Regression analyses demonstrated that uninsured patients were significantly less likely to have an MRI, CT, or X-ray study ordered (P < .001 for all modalities) and completed (P < .001 for MRI and X-ray, P = .03 for CT). Patients with lower income had higher rates of MRI, CT, and X-ray (P < .001 for all) imaging ordered but were less likely to have an ordered X-ray be completed (P = .009). There was no significant difference in the completion rate of ordered MRIs or CTs.
  
  
  CONCLUSIONS
  Disparities in image utilization based on socioeconomic characteristics such as insurance status and income level highlight a critical gap in access to health care. Physicians should work to mitigate the influence of such factors when deciding whether to order imaging studies, especially in light of the ongoing shift in health policy in the United States.
authors.affiliation: *Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Center for Spine Health, and Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio; ‡Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, Ohio.
authors.forename: Adeeb
authors.initials: A
authors.lastname: Derakhshan
authors.forename: Jacob
authors.initials: J
authors.lastname: Miller
authors.forename: Daniel
authors.initials: D
authors.lastname: Lubelski
authors.forename: Amy S
authors.initials: AS
authors.lastname: Nowacki
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Wells
authors.forename: Alex
authors.initials: A
authors.lastname: Milinovich
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
authors.forename: Michael P
authors.initials: MP
authors.lastname: Steinmetz
mesh_terms: D005260:Female; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000191:economics; D012044:Regression Analysis; D012189:Retrospective Studies; D012923:Social Class; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000191:economics; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States