医疗保险受益癌症患者中 PET 使用的地理和社会人口差异。
Geographic and sociodemographic disparities in PET use by Medicare beneficiaries with cancer.
机构信息
Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, New Hampshire 03756, USA.
出版信息
J Am Coll Radiol. 2012 Sep;9(9):635-42. doi: 10.1016/j.jacr.2012.05.005.
PURPOSE
PET use for cancer care has increased unevenly, possibly because of regional health care market characteristics or underlying population characteristics. The aim of this study was to examine variation in advanced imaging use among individuals with cancer in relation to population and hospital service area (HSA) characteristics.
METHODS
A retrospective national study of fee-for-service Medicare beneficiaries with diagnoses of 1 of 5 cancers covered by Medicare for PET (2004-2008) was conducted. Crude and adjusted rates of PET, CT, and MRI were estimated for HSAs and sociodemographic subgroups. Generalized linear mixed models were used to assess the effects of race/ethnicity, area-level income, and HSA-level physician supply and spending on imaging utilization.
RESULTS
On the basis of an annual average of 116,452 beneficiaries with cancer, adjusted PET rates (imaging days per person-year) showed significantly higher use for whites compared with blacks in both 2004 (whites, 0.35 [95% confidence interval, 0.34-0.36]; blacks, 0.31 [95% confidence interval, 0.30-0.33]) and 2008 (whites, 0.64 [95% confidence interval, 0.63-0.65]; blacks, 0.57 [95% confidence interval, 0.55-0.59]). This trend was similar for the highest quartile of group-level median household income but was opposite for CT use, with blacks having higher rates than whites. The highest Medicare-spending HSAs had significantly higher adjusted PET rates compared with lower spending areas (0.57 [95% confidence interval, 0.55-0.60] vs 0.69 [95% confidence interval, 0.67-0.71] imaging days/person-year).
CONCLUSIONS
The use of PET among Medicare beneficiaries with cancer increased from 2004 to 2008, with higher rates observed among whites, among higher socioeconomic groups, and in higher Medicare spending areas. Sociodemographic differences in advanced imaging use are modality specific.
目的
由于区域医疗保健市场特征或潜在人口特征，癌症患者对 PET 的使用存在不均衡的增长。本研究的目的是检查癌症患者中高级影像学使用的变化与人口和医院服务区域（HSA）特征之间的关系。
方法
对医疗保险受益人的回顾性全国性研究，这些人在 2004-2008 年间被诊断患有五种癌症之一，这些癌症涵盖了医疗保险的 PET 范围。对 HSA 和社会人口亚组的 PET、CT 和 MRI 的粗率和调整率进行了估计。使用广义线性混合模型评估种族/民族、地区收入水平以及 HSA 级医生供应和影像利用对影像利用的影响。
结果
基于每年平均有 116452 名癌症患者，调整后的 PET 率（每人每年的影像天数）显示，与黑人相比，白人在 2004 年（白人，0.35 [95%置信区间，0.34-0.36]；黑人，0.31 [95%置信区间，0.30-0.33]）和 2008 年（白人，0.64 [95%置信区间，0.63-0.65]；黑人，0.57 [95%置信区间，0.55-0.59]）的使用率明显更高。对于群体中位数家庭收入最高的四分位数，这种趋势是相似的，但 CT 使用率则相反，黑人的使用率高于白人。医疗保险支出最高的 HSA 与支出较低的地区相比，调整后的 PET 率显著更高（0.57 [95%置信区间，0.55-0.60]与 0.69 [95%置信区间，0.67-0.71]的影像天数/人年）。
结论
从 2004 年到 2008 年，医疗保险受益人的癌症患者对 PET 的使用有所增加，白人、社会经济地位较高的人群以及医疗保险支出较高的地区的使用率较高。高级影像学使用的社会人口差异是特定于模式的。
Zotero 插件