Disease burden linked w/ higher rad exposure among poor children

Children living in high poverty areas are exposed to higher levels of cumulative radiation, according to a study published in the November issue of the Journal of American College of Radiology. However, as researchers analyzed the relationship between socioeconomic status and radiation exposure, they linked disease burden, rather than poverty, with higher radiation exposure among poor children.

Given concerns about radiation exposure among children as well as healthcare disparities by race and socioeconomic status (SES), Katherine Freeman, DrPH, of Montefiore Medical Center in Bronx, N.Y., and colleagues sought to test the association in children between socioeconomic status and radiation exposure.   

“We hypothesized that because of increased disease burden, lower SES may contribute to an increase in exposure to medical ionizing radiation,” wrote Freeman et al.

The retrospective cohort study focused on 19,063 pediatric patients who underwent imaging exams during an index visit in January 2006. Researchers mined the EHR to determine all diagnostic radiology exams performed for three years from the original outpatient visit and used mean radiation doses to calculate cumulative radiation exposure from diagnostic imaging (CEDI).

They incorporated comorbidities into the analysis, focusing on 26 Elixhauser diagnoses.

Among the children in the study, 27 percent lived in poverty and 62 percent resided in areas where more than 20 percent of residents live below the poverty level. The researchers’ analysis showed that children living in areas of greater poverty had higher levels of cumulative radiation exposure. “However,” they wrote, “analyses that controlled for age and diagnosis attributed this finding primarily to burden of disease.”

Specifically, Freeman and colleagues reported an association between lower SES and greater disease burden. Approximately 36 percent of children had at least one Elixhauser diagnosis, and these children lived in poorer environments, according to Freeman et al. They found children enrolled in Medicaid or Medicare, who are poor and have Elixhauser diagnoses, received significantly more radiation than those with private or no insurance.

The researchers referred to an earlier study, paralleling the design of the current study with adult patients, which showed radiation exposure was linked to comorbidities rather than SES.

“Our study demonstrates that poorer children have increased burden of disease and as a consequence receive more CEDI,” concluded Freeman and colleagues. They suggested that awareness of higher overall potential radiation exposure among this population may lead to efforts to employ nonionizing alternatives and curb radiation exposure.