Medical imaging utilization in migrants compared with nonmigrants in a universal healthcare system: A population-based matched cohort study.

IF 15.8 1区 医学 Q1 Medicine
PLoS Medicine Pub Date : 2024-10-22 eCollection Date: 2024-10-01 DOI:10.1371/journal.pmed.1004474
Giancarlo Di Giuseppe, Rinku Sutradhar, Priscila Pequeno, Marilyn L Kwan, Diana L Miglioretti, Rebecca Smith-Bindman, Jason D Pole
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引用次数: 0

Abstract

Background: Medical imaging is an integral part of healthcare. Globalization has resulted in increased mobilization of migrants to new host nations. The association between migration status and utilization of medical imaging is unknown.

Methods and findings: A retrospective population-based matched cohort study was conducted in Ontario, Canada from April 1, 1995 to December 31, 2016. A total of 1,848,222 migrants were matched 1:1 to nonmigrants in the year of migration on age, sex, and geography. Utilization of computed tomography (CT), magnetic resonance imaging (MRI), radiography, and ultrasonography was determined. Rate differences per 1,000 person-years comparing migrants to nonmigrants were calculated. Relative rates were calculated using a recurrent event framework, adjusting for age, sex, and time-varying socioeconomic status, comorbidity score, and access to a primary care provider. Estimates were stratified by migration age: children and adolescents (≤19 years), young adults (20 to 39), adults (40 to 59), and older adults (≥60). Utilization rates of CT, MRI, and radiography were lower for migrants across all age groups compared with Ontario nonmigrants. Increasing age at migration was associated with larger differences in utilization rates. Older adult migrants had the largest gap in imaging utilization. The longer the time since migration, the larger the gap in medical imaging use. In multivariable analysis, the relative rate of imaging was approximately 20% to 30% lower for migrants: ranging from 0.77 to 0.88 for CT and 0.72 to 0.80 for MRI imaging across age groups. Radiography relative rates ranged from 0.84 to 0.90. All migrant age groups, except older adults, had higher rates of ultrasonography. The indication for imaging was not captured, thus it was not possible to determine if the imaging was necessary.

Conclusions: Migrants utilized less CT, MRI, and radiography but more ultrasonography. Older adult migrants used the least amount of imaging compared with nonmigrants. Future research should evaluate whether lower utilization is due to barriers in healthcare access or health-seeking behaviors within a universal healthcare system.

在全民医疗保健系统中,移民与非移民的医学影像使用情况比较:基于人群的匹配队列研究。
背景:医学影像是医疗保健不可或缺的一部分。全球化导致越来越多的移民被动员到新的东道国。移民身份与医学影像利用率之间的关系尚不清楚:从 1995 年 4 月 1 日至 2016 年 12 月 31 日,在加拿大安大略省开展了一项基于人口的匹配队列回顾性研究。共有 1,848,222 名移民与移民当年的非移民在年龄、性别和地域方面进行了 1:1 匹配。对计算机断层扫描(CT)、磁共振成像(MRI)、放射摄影和超声波检查的使用情况进行了测定。计算了移民与非移民每千人年的比率差异。相对比率采用复发性事件框架进行计算,并对年龄、性别和随时间变化的社会经济状况、合并症评分以及获得初级保健提供者服务的情况进行调整。估计值按迁移年龄进行分层:儿童和青少年(≤19 岁)、年轻成人(20 至 39 岁)、成人(40 至 59 岁)和老年人(≥60 岁)。与安大略省非移民相比,各年龄组移民的CT、核磁共振成像和放射摄影使用率均较低。移民年龄越大,使用率差异越大。老年移民在成像利用率方面的差距最大。移民时间越长,医学影像使用率的差距就越大。在多变量分析中,移民的影像学相对利用率约低 20% 至 30%:不同年龄组的 CT 和 MRI 影像学相对利用率分别为 0.77 至 0.88 和 0.72 至 0.80。放射成像的相对比率从 0.84 到 0.90 不等。除老年人外,所有移民年龄组的超声波检查率都较高。成像的适应症未被记录,因此无法确定成像是否必要:结论:移民使用的 CT、MRI 和放射线检查较少,但超声波检查较多。与非移民相比,老年移民使用的造影剂最少。未来的研究应评估较低的使用率是否是由于在全民医疗保健系统中医疗保健服务的障碍或寻求健康的行为造成的。
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来源期刊
PLoS Medicine
PLoS Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
17.60
自引率
0.60%
发文量
227
审稿时长
4-8 weeks
期刊介绍: PLOS Medicine is a prominent platform for discussing and researching global health challenges. The journal covers a wide range of topics, including biomedical, environmental, social, and political factors affecting health. It prioritizes articles that contribute to clinical practice, health policy, or a better understanding of pathophysiology, ultimately aiming to improve health outcomes across different settings. The journal is unwavering in its commitment to uphold the highest ethical standards in medical publishing. This includes actively managing and disclosing any conflicts of interest related to reporting, reviewing, and publishing. PLOS Medicine promotes transparency in the entire review and publication process. The journal also encourages data sharing and encourages the reuse of published work. Additionally, authors retain copyright for their work, and the publication is made accessible through Open Access with no restrictions on availability and dissemination. PLOS Medicine takes measures to avoid conflicts of interest associated with advertising drugs and medical devices or engaging in the exclusive sale of reprints.
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