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

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.已有近期研究表明，贫困弱势地区的儿童相较于其他地区儿童，接受计算机断层扫描（Computed Tomography，简称CT）的频率更高。本研究旨在评估西班牙接受CT扫描的青年受试者中，基于社会经济地位（Socioeconomic Status，简称SES）的CT影像检查潜在差异，并探究此类差异是否随不同指标或不同时间点的社会经济地位测量结果而变化。本研究针对西班牙EPI-CT亚队列，分析了CT扫描与SES之间的关联，以及每位患者的CT扫描频次与SES之间的关联。研究纳入多种SES指标，以明确特定的社会经济地位维度是否与接受单次或多次CT扫描的概率相关性更强。研究以2001年与2011年人口普查数据为基础构建指数，并开展对比分析。研究发现青年受试者中存在社会经济差异，此类差异主要与所居住的西班牙自治区相关。研究观察到，社会经济地位较低的群体中，每位患者接受多部位CT扫描的频次略高，这或许反映出此类群体的事故与暴力发生率更高。社会经济地位最高与最低的群体中，每位患者的CT扫描次数均更高，而中间阶层群体的扫描次数则相对较低。这种关联随所采用的SES指标不同而有所变化：在高失业率与临时用工类型的群体中，患者的CT扫描频次更低，但该关联并不受非技术工种或文盲率类别的影响。2011年普查数据对应的各项指标与CT扫描次数之间的关联，与2001年普查数据的结果存在差异：在2011年的分析中，CT扫描次数随失业率升高而增加。整体而言，我们观察到西班牙各自治区内接受CT扫描的患者的SES分布存在一定差异。不过基于2001年的普查数据，整体上按SES划分的每位患者CT扫描频次并未出现显著差异。采用不同指标以及不同时间点收集的SES数据，会导致SES与CT扫描频次之间的关联出现差异，这也凸显了精准捕捉可能影响健康与医疗服务利用的社会经济维度所面临的挑战。