Sociodemographic factors and Child Opportunity Index disparities associated with missed care opportunities in pediatric patients with lymphoma and leukemia referred for FDG-PET/CT

Samantha Harrington; Neha Kwatra; Patrice Melvin; Ashley B Tartarilla; Melicia Y Whitley; Valentina Ferrer Valencia; Valerie L Ward

doi:10.1007/s00247-024-05924-6

Sociodemographic factors and Child Opportunity Index disparities associated with missed care opportunities in pediatric patients with lymphoma and leukemia referred for FDG-PET/CT

Pediatr Radiol. 2024 Apr 18. doi: 10.1007/s00247-024-05924-6. Online ahead of print.

Authors

Samantha Harrington^#¹, Neha Kwatra^#^{2

3}, Patrice Melvin^{4

5}, Ashley B Tartarilla⁴, Melicia Y Whitley⁴, Valentina Ferrer Valencia⁶, Valerie L Ward^{6

7

4

5}

Affiliations

¹ Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
² Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. neha.kwatra@childrens.harvard.edu.
³ Harvard Medical School, Boston, MA, USA. neha.kwatra@childrens.harvard.edu.
⁴ Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA.
⁵ Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA.
⁶ Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
⁷ Harvard Medical School, Boston, MA, USA.

^# Contributed equally.

PMID: 38632134
DOI: 10.1007/s00247-024-05924-6

Abstract

Background: Little data exists on the association of missed care opportunities (MCOs) in children referred for nuclear medicine/nuclear oncology imaging examinations and socioeconomic disparities.

Objective: To determine the prevalence of MCOs in children with lymphoma/leukemia scheduled for fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and the impact of sociodemographic factors and Child Opportunity Index (COI).

Materials and methods: Retrospective analysis of MCOs in children with lymphoma/leukemia scheduled for FDG-PET/CT (2012 to 2022) was performed. In univariate analysis, patient, neighborhood, and appointment data were assessed across MCOs and completed appointments. Logistic regression evaluated independent effects of patient-, neighborhood-, and appointment-level factors with MCOs. Two-sided P-value < .05 was considered statistically significant.

Results: In 643 FDG-PET/CT appointments (n = 293 patients; median age 15 years (IQR 11.0-17.0 years); 37.9% female), there were 20 MCOs (3.1%) involving 16 patients. Only 8.2% appointments involved Black/African American non-Hispanic/Latino patients, yet they made up a quarter of total MCOs. Patients living in neighborhoods with very low or low COI experienced significantly higher MCOs versus zip codes with very high COI (6.9% vs. 0.8%; P = 0.02). Logistic regression revealed significantly increased likelihood of MCOs for patients aged 18 to 21 [odds ratio (OR) 4.50; 95% CI 1.53-13.27; P = 0.007], Black/African American non-Hispanic/Latino (OR 3.20; 95% CI 1.08-9.49; P = 0.04), zip codes with very low or low COI (OR 9.60; 95% CI 1.24-74.30; P = 0.03), and unknown insurance status.

Conclusion: Children with lymphoma/leukemia, living in zip codes with very low or low COI, and who identified as Black/African American non-Hispanic/Latino experienced more MCOs. Our study supports the need to address intersecting sociodemographic, neighborhood, and health system factors that will improve equitable access to necessary healthcare imaging for children.

Keywords: Child Opportunity Index (COI); Children; Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT); Health equity; Lymphoma; Missed care opportunities (MCOs).