CT scan exposure in Spanish children and young adults by socioeconomic status: Cross-sectional analysis of cohort data

PLOS ONE, Nov 2019

Recent publications reported that children in disadvantaged areas undergo more CT scanning than others. The present study is aimed to assess the potential differences in CT imaging by socioeconomic status (SES) in Spanish young scanned subjects and if such differences vary with different indicators or different time point SES measurements. The associations between CT scanning and SES, and between the CT scan rate per patient and SES were investigated in the Spanish EPI-CT subcohort. Various SES indicators were studied to determine whether particular SES dimensions were more closely related to the probability of undergoing one or multiple CTs. Comparisons were made with indices based on 2001 and 2011 censuses. We found evidence of socio-economic variation among young people, mainly related to autonomous communities of residence. A slightly higher rate of scans per patient of multiple body parts in the less affluent categories was observed, possibly reflecting a higher rate of accidents and violence in these groups. The number of CT scans per patient was higher both in the most affluent and the most deprived categories and somewhat lower in the intermediate groups. This relation varied with the SES indicator used, with lower CT scans per patients in categories of high unemployment and temporary work, but not depending on categories of unskilled work or illiteracy. The relationship between these indicators and number of CTs in 2011 was different than that seen with the 2001 census, with the number of CTs increasing with higher unemployment. Overall we observed some differences in the SES distribution of scanned patients by Autonomous Community in Spain. There was, however, no major differences in the frequency of CT scans per patient by SES overall, based on the 2001 census. The use of different indicators and of SES data collected at different time points led to different relations between SES and frequency of CT scans, outlining the difficulty of adequately capturing the social and economic dimensions which may affect health and health service utilisation.

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CT scan exposure in Spanish children and young adults by socioeconomic status: Cross-sectional analysis of cohort data

May CT scan exposure in Spanish children and young adults by socioeconomic status: Cross- sectional analysis of cohort data Magda Bosch de Basea 0 1 Ana Espinosa 0 1 Mariona Gil 0 1 Jordi Figuerola 0 1 Marina Pardina 1 Jos e Vilar 1 Elisabeth Cardis 0 1 0 Radiation epidemiology, Barcelona Institute for Global Health (ISGlobal) , Barcelona , Spain , 2 Universitat Pompeu Fabra (UPF) , Barcelona, Spain, 3 CIBER EpidemiologÂõa y Salud Pu blica (CIBERESP), Madrid , Spain , 4 Hospital Universitari Arnau de Vilanova , Lleida , Spain , 5 Hospital Universitario Doctor Peset , Valencia , Spain 1 Editor: C. Mary Schooling , CUNY , UNITED STATES Recent publications reported that children in disadvantaged areas undergo more CT scanning than others. The present study is aimed to assess the potential differences in CT imaging by socioeconomic status (SES) in Spanish young scanned subjects and if such differences vary with different indicators or different time point SES measurements. The associations between CT scanning and SES, and between the CT scan rate per patient and SES were investigated in the Spanish EPI-CT subcohort. Various SES indicators were studied to determine whether particular SES dimensions were more closely related to the probability of undergoing one or multiple CTs. Comparisons were made with indices based on 2001 and 2011 censuses. We found evidence of socio-economic variation among young people, mainly related to autonomous communities of residence. A slightly higher rate of scans per patient of multiple body parts in the less affluent categories was observed, possibly reflecting a higher rate of accidents and violence in these groups. The number of CT scans per patient was higher both in the most affluent and the most deprived categories and somewhat lower in the intermediate groups. This relation varied with the SES indicator used, with lower CT scans per patients in categories of high unemployment and temporary work, but not depending on categories of unskilled work or illiteracy. The relationship between these indicators and number of CTs in 2011 was different than that seen with the 2001 census, with the number of CTs increasing with higher unemployment. Overall we observed some differences in the SES distribution of scanned patients by Autonomous Community in Spain. There was, however, no major differences in the frequency of CT scans per patient by SES overall, based on the 2001 census. The use of different indicators and of SES data collected at different time points led to different relations between SES and frequency of CT scans, outlining the difficulty of adequately capturing the social and economic dimensions which may affect health and health service utilisation. - Data Availability Statement: Data cannot be made publicly available by us for ethical, contractual and legal reasons. The Agency of Quality and Healthcare Evaluation of Catalonia (Agencia de Calidad y EvaluacioÂn Sanitarias de Cataluña) who has the custody over this data granted us temporary access for the analyses. Interested researchers may request access to a minimal, deidentified data set from Ramon Roman (), who is in charge of the information system at the Agency of Quality and Healthcare Evaluation of Catalonia. Funding: This work was partly supported by the European Community's Seventh Framework Programme (FP7/2007-2013) (https://ec.europa. eu/research/fp7/index_en.cfm) [grant number 269912 - EPI-CT: Epidemiological study to quantify risks for paediatric computerized tomography and to optimise doses]. Complementary funding was received from the Consejo de Seguridad Nuclear (https://www.csn.es/home). M. Bosch de Basea was the recipient of a fellowship of the Centro de InvestigacioÂn BiomeÂdica en Red de EpidemiologÂõa y Salud PuÂblica (CIBERESP) (http://www.ciberesp. es/) Instituto de Salud Carlos III (ES) for a short stay abroad at Newcastle University. ISGlobal is part of the CERCA Programme / Generalitat de Catalunya (http://cerca.cat/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Background Almost 4 million computed tomography (CT) scans are performed annually in Spain [ 1 ], allowing for non-invasive detailed imagery of human anatomical inner structures. Despite its clinical advantages, the low to moderate doses of ionising radiation imparted in CT scanning have been associated with an increased risk of brain tumours and leukaemia in children and young adults [2±5]. Four recent papers have reported higher radiation doses and CT scan use in children living in disadvantaged areas [6±9]. In all of them, this finding was hypothetically attributed to a higher disease and injury rate compared to more affluent areas. The influence of the socioeconomic status (SES), the complex phenomenon that embodies economic, political, occupational and cult (...truncated)


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Magda Bosch de Basea, Ana Espinosa, Mariona Gil, Jordi Figuerola, Marina Pardina, José Vilar, Elisabeth Cardis. CT scan exposure in Spanish children and young adults by socioeconomic status: Cross-sectional analysis of cohort data, PLOS ONE, 2018, Volume 13, Issue 5, DOI: 10.1371/journal.pone.0196449