Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
School of Public Health, University of Queensland, Brisbane, Queensland, Australia.
PLoS One. 2020 Dec 3;15(12):e0243282. doi: 10.1371/journal.pone.0243282. eCollection 2020.
There are concerns that lumbar spine imaging represents low value care. Our aim was to examine the use of lumbar spine imaging [radiography, computed tomography (CT), magnetic resonance imaging (MRI)] over 20 years, and costs and person-level characteristics of imaging in a large cohort of Australian women.
The Australian Longitudinal Study on Women's Health (ALSWH) is a longitudinal population-based survey of women randomly selected from national health insurance scheme (Medicare) database. This study examined 13458 women born in 1973-1978 who consented to link their ALSWH and Medical Benefits Scheme records. Self-reported data on demographics, body mass index, depression, physical and mental health, and back pain were collected in each survey performed in 1996, 2000, 2003, 2006, 2009, 2012, and 2015. Data on lumbar spine imaging from 1996 to 2015 were obtained from the Medical Benefits Scheme database.
38.9% of women underwent some form of lumbar spine imaging over 20 years. While radiography increased from 1996 to 2011 and decreased thereafter, CT and MRI continued to increase from 1996 to 2015. In women with self-reported back pain, depression and poorer physical health were associated with imaging, with no significant differences in types of imaging. Based on imaging rates in ALSWH, the estimated costs for Australian women aged 30-39 years were AU$51,735,649 over 2011-2015.
Lumbar spine imaging was common in population-based Australian women, with rates increasing over 20 years. Depression and poor physical health were associated with lumbar spine imaging. Raising awareness of this in clinicians is likely to result in significant cost savings if clinical guidelines are followed, with the potential of freeing resources for high value care and health outcomes.
人们担心腰椎影像学检查代表低价值的医疗服务。本研究旨在调查 20 多年来腰椎影像学（X 线摄影、计算机断层扫描 [CT]、磁共振成像 [MRI]）的使用情况以及在一大群澳大利亚女性中影像学的成本和个体特征。
澳大利亚女性健康纵向研究（ALSWH）是一项基于人群的纵向调查，对象是从国家健康保险计划（医疗保险）数据库中随机选择的女性。这项研究调查了 1973-1978 年出生并同意将其 ALSWH 和医疗福利计划记录进行关联的 13458 名女性。在 1996 年、2000 年、2003 年、2006 年、2009 年、2012 年和 2015 年进行的每次调查中都收集了人口统计学、体重指数、抑郁、身心健康和背痛等方面的自我报告数据。从 1996 年到 2015 年的腰椎影像学数据来自医疗福利计划数据库。
20 年来，38.9%的女性接受了某种形式的腰椎影像学检查。虽然 X 射线摄影从 1996 年到 2011 年增加，此后减少，但 CT 和 MRI 从 1996 年到 2015 年继续增加。在有背痛自我报告的女性中，抑郁和较差的身体健康与影像学检查相关，影像学检查类型没有显著差异。根据 ALSWH 的影像学检查率，估计 2011-2015 年澳大利亚 30-39 岁女性的估计费用为 51735649 澳元。
在澳大利亚基于人群的女性中，腰椎影像学检查很常见，20 年来检查率不断上升。抑郁和较差的身体健康与腰椎影像学检查相关。如果遵循临床指南，提高临床医生对此的认识，可能会节省大量成本，并为高价值护理和健康结果腾出资源。
