Key result
Self-referred CAC patients are linked to higher-income areas and ~8% more zero scores vs physician referral.
Why the study?
Coronary artery calcium testing often requires out-of-pocket payment and can be obtained via self-referral or physician referral, but differences in patient, socioeconomic, and scan characteristics between these referral pathways were unexamined.
Are there differences in patient demographics, socioeconomic status, and CAC scores between self-referred and physician-referred populations undergoing CAC scanning?
Observational (n=19,726)
Yes
Are there differences in patient demographics, socioeconomic status, and CAC scores between self-referred and physician-referred populations undergoing CAC scanning?
Self-referred CAC scanning is predominantly utilized by individuals in higher-income areas with fewer cardiovascular risk factors, highlighting socioeconomic disparities in access to this preventive tool.
BACKGROUND: Coronary artery calcium computed tomography (CAC) is an important tool for identifying subclinical atherosclerosis and cardiovascular risk stratification. Despite robust evidence and inclusion in current guidelines, CAC is considered investigational by some US insurance carriers and requires out-of-pocket expenses. CAC can be obtained via self-referral (SR) or physician referral (PR). We aimed to examine differences in patient, socioeconomic, and CAC characteristics between referral groups. METHODS: We evaluated demographic, medical history, and CAC results of consecutive patients with a CAC completed at one of multiple Wisconsin sites from March 1, 2019, to June 30, 2021. We separated patients into SR and PR groups. Through census data, we analyzed socioeconomic variables at the block level including race and ethnicity, median income, average household size, and high school completion in the areas where patients resided at the time of CAC. RESULTS: The final analysis included 19 726 patients: 13 835 (70.1%) PR and 5891 (29.9%) SR. Most patients in both groups were White (95.2% versus 95.1%), with the Black/African American population representing 2.7% (SR) and 2.3% (PR). The PR group had a higher prevalence of cardiovascular risk factors. SR patients were more likely to have a score of 0 (41.2% versus 38.1%; P <0.001); PR patients had a higher prevalence of CAC >300 (16.8% versus 14.8%; P <0.001). SR patients were more likely to be women (55.1% versus 48.9%; P <0.001) and were found to live in higher income areas (19.5% versus 16.4%; P <0.001). Patients from low-income areas comprised the smallest proportion in both groups (7.5%). CONCLUSIONS: Patients who obtain out-of-pocket CAC live predominantly in medium- and high-income areas, and patients from lower income locations are less likely to obtain CAC despite having more cardiovascular disease risk factors. Consideration should be made from a policy perspective to promote health equity and improve utilization of CAC testing among underrepresented groups.
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Marzlin et al. (2024) conducted an observational in Subclinical atherosclerosis (n=19,726). Self-referral vs. Physician referral was evaluated on CAC score of 0 (p=<0.001). Self-referred patients for coronary artery calcium scanning were more likely to have a CAC score of 0 (41.2% vs 38.1%; P<0.001) and live in higher-income areas than physician-referred patients.
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