Health Disparities Forum

Some of the social determinants that are most relevant to my area of research (radiology) are: the structural stratifiers race/ethnicity, gender, income, and the intermediary determinant consumption potential. In particular, I am using a published study from 2008 entitled "Racial/Ethnic Disparities in Time to Follow-Up after an Abnormal Mammogram" as an example of the type of ongoing research that aims to examine the relationship between these social determinants and radiologic outcomes. This was a retrospective cohort study of 6722 women patients followed at an academic medical center in New York City. The study found that African American and Hispanic women had longer times from abnormal mammogram to diagnostic follow-up compared to non-Hispanic white women. This was found to be true even after the authors controlled for age, Breast Imaging Reporting and Data System (BIRADS) category, insurance status, location of provider practice , and median household income. I thought that the results of this study further supported Braveman's point that "racial/ethnic differences also cannot be assumed to be reducible to socioeconomic issues," as race/ethnicity was shown to still be significant after controlling for median household income. With regard to life course, it would be interesting to compare this study with one that examines disparities in time to follow-up after abnormal results in another type of medical imaging, particularly one in which younger patients would be more likely to be included. Mammograms are recommended for women over age 50, so it would be interesting to see if the results of this study applied to younger patients (to examine how this factor might function over the life course).

2. Write a brief paragraph describing the extent to which an socioecological framework incorporating issues related to social determinants has been applied to your area of research. Are there opportunities for improving our understanding of or approach to disparities in your area with a greater emphasis on a socioecological framework?

In my experience as a medical student thus far, “social determinants of health” and “radiology” were almost never used in the same sentence, so I had to do a literature search to learn more about their relationship. It turns out that the majority of the world’s population has limited access to radiological services and advanced medical imaging. In the United States, there are many disparities with regard to who receive radiological services. Researchers have studied questions such as mammography utilization rates among African-American and Hispanic women, utilization rates of low-dose CT screening for lung cancer among patients of different races and SES levels, disparities in stroke intervention (interventional radiology), and disparities in the ordering of medical imaging for patients of different races who present to the emergency department. Still, there are many opportunities to use a socioecological framework to improve our understanding of health care disparities in radiology. Public health scholars are seeking radiologists who can serve as research partners to help provide clinical expertise and context. Very interestingly, there is also a need to assess the impact of various interventions designed to reduce health care disparities, such as medical imaging screening programs tailored to high-risk patients of minority populations.

References:

-Press, Rebecca, et al. "Racial/Ethnic Disparities in Time to Follow-Up after an Abnormal Mammogram." J Womens Health (Larchmt). 2008 Jul; 17(6): 923–930. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2942754/.