Racial and ethnic disparities in pediatric magnetic resonance imaging missed care opportunities.

ABSTRACT

BACKGROUND: Imaging missed care opportunities (MCOs), previously referred to as "no shows," impact timely patient diagnosis and treatment and can exacerbate health care disparities. Understanding factors associated with imaging MCOs could help advance pediatric health equity. OBJECTIVE: To assess racial/ethnic differences in pediatric MR imaging MCOs and whether health system and socioeconomic factors, represented by a geography-based Social Vulnerability Index (SVI), influence racial/ethnic differences. MATERIALS AND METHODS: We conducted a retrospective analysis of MR imaging MCOs in patients younger than 21 years at a pediatric academic medical center (2015-2019). MR imaging MCOs were defined as scheduled but appointment not attended, canceled within 24 h, and canceled but not rescheduled. Mixed effects multivariable logistic regression assessed the association between MCOs and race/ethnicity and community-level social factors, represented by the SVI. RESULTS: Of 68,809 scheduled MRIs, 6,159 (9.0%) were MCOs. A higher proportion of MCOs were among Black/African-American and Hispanic/Latino children. Multivariable analysis demonstrated increased odds of MCOs among Black/African-American (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.7-2.3) and Hispanic/Latino (aOR 1.5, 95% CI 1.3-1.7) children compared to White children. The addition of SVI >90th percentile to the adjusted model had no effect on adjusted OR for Black/African-American (aOR 1.9, 95% CI 1.7-2.2) or Hispanic/Latino (aOR 1.5, 95% CI 1.3-1.6) children. Living in a community with SVI >90th percentile was independently associated with MCOs. CONCLUSION: Black/African-American and Hispanic/Latino children were almost twice as likely to experience MCOs, even when controlling for factors associated with MCOs. Independent of race/ethnicity, higher SVI was significantly associated with MCOs. Our study supports that pediatric health care providers must continue to identify systemic barriers to health care access for Black/African-American and Hispanic/Latino children and those from socially vulnerable areas.