Trends in Use of Medical Imaging in US Health Care Systems and in Ontario, Canada, 2000-2016,JAMA

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Trends in Use of Medical Imaging in US Health Care Systems and in Ontario, Canada, 2000-2016
JAMA ( IF 63.1 ) Pub Date : 2019-09-03 , DOI: 10.1001/jama.2019.11456
Rebecca Smith-Bindman ₁ , Marilyn L Kwan ₂ , Emily C Marlow _{3,

4} , Mary Kay Theis ₅ , Wesley Bolch ₆ , Stephanie Y Cheng ₇ , Erin J A Bowles ₅ , James R Duncan ₈ , Robert T Greenlee ₉ , Lawrence H Kushi ₂ , Jason D Pole _{7,

10} , Alanna K Rahm ₁₁ , Natasha K Stout ₁₂ , Sheila Weinmann ₁₃ , Diana L Miglioretti _{3,

5}

Affiliation

Department of Radiology and Biomedical Imaging, Epidemiology and Biostatistics, and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.
Division of Research, Kaiser Permanente Northern California, Oakland.
Department of Public Health Sciences, University of California, Davis.
Graduate Group in Epidemiology, University of California, Davis.
Kaiser Permanente Washington Health Research Institute, Seattle.
J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville.
ICES, Toronto, Ontario, Canada.
Interventional Radiology Section, Washington University in St Louis, St Louis, Missouri.
Marshfield Clinic Research Institute, Marshfield, Wisconsin.
Pediatric Oncology Group of Ontario and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Center for Health Research, Genomic Medical Institute, Geisinger, Danville, Pennsylvania.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.

Importance Medical imaging increased rapidly from 2000 to 2006, but trends in recent years have not been analyzed. Objective To evaluate recent trends in medical imaging. Design, Setting, and Participants Retrospective cohort study of patterns of medical imaging between 2000 and 2016 among 16 million to 21 million patients enrolled annually in 7 US integrated and mixed-model insurance health care systems and for individuals receiving care in Ontario, Canada. Exposures Calendar year and country (United States vs Canada). Main Outcomes and Measures Use of computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and nuclear medicine imaging. Annual and relative imaging rates by imaging modality, country, and age (children [<18 years], adults [18-64 years], and older adults [≥65 years]). Results Overall, 135 774 532 imaging examinations were included; 5 439 874 (4%) in children, 89 635 312 (66%) in adults, and 40 699 346 (30%) in older adults. Among adults and older adults, imaging rates were significantly higher in 2016 vs 2000 for all imaging modalities other than nuclear medicine. For example, among older adults, CT imaging rates were 428 per 1000 person-years in 2016 vs 204 per 1000 in 2000 in US health care systems and 409 per 1000 vs 161 per 1000 in Ontario; for MRI, 139 per 1000 vs 62 per 1000 in the United States and 89 per 1000 vs 13 per 1000 in Ontario; and for ultrasound, 495 per 1000 vs 324 per 1000 in the United States and 580 per 1000 vs 332 per 1000 in Ontario. Annual growth in imaging rates among US adults and older adults slowed over time for CT (from an 11.6% annual percentage increase among adults and 9.5% among older adults in 2000-2006 to 3.7% among adults in 2013-2016 and 5.2% among older adults in 2014-2016) and for MRI (from 11.4% in 2000-2004 in adults and 11.3% in 2000-2005 in older adults to 1.3% in 2007-2016 in adults and 2.2% in 2005-2016 in older adults). Patterns in Ontario were similar. Among children, annual growth for CT stabilized or declined (United States: from 10.1% in 2000-2005 to 0.8% in 2013-2016; Ontario: from 3.3% in 2000-2006 to -5.3% in 2006-2016), but patterns for MRI were similar to adults. Changes in annual growth in ultrasound were smaller among adults and children in the United States and Ontario compared with CT and MRI. Nuclear medicine imaging declined in adults and children after 2006. Conclusions and Relevance From 2000 to 2016 in 7 US integrated and mixed-model health care systems and in Ontario, rates of CT and MRI use continued to increase among adults, but at a slower pace in more recent years. In children, imaging rates continued to increase except for CT, which stabilized or declined in more recent periods. Whether the observed imaging utilization was appropriate or was associated with improved patient outcomes is unknown.

中文翻译：

2000-2016 年美国医疗保健系统和加拿大安大略省医学影像使用趋势

重要性医学影像从2000年到2006年迅速增长，但近年来的趋势尚未分析。目的评估医学成像的最新趋势。设计、设置和参与者对 2000 年至 2016 年间每年登记在 7 个美国综合和混合模式保险医疗保健系统中的 1600 万至 2100 万患者以及在加拿大安大略省接受护理的个人的医学影像模式进行回顾性队列研究。曝光日历年份和国家/地区（美国与加拿大）。主要成果和措施使用计算机断层扫描 (CT)、磁共振成像 (MRI)、超声和核医学成像。按成像方式、国家和年龄（儿童 [<18 岁]、成人 [18-64 岁] 和老年人 [≥65 岁]）划分的年度和相对成像率。结果总体而言，纳入了 135 774 532 次影像学检查；儿童为 5 439 874 (4%)，成人为 89 635 312 (66%)，老年人为 40 699 346 (30%)。在成人和老年人中，2016 年除核医学以外的所有成像方式的成像率均显着高于 2000 年。例如，在老年人中，2016 年美国医疗保健系统的 CT 成像率为每 1000 人年 428 例，而 2000 年为每 1000 人年 204 例；安大略省为每 1000 人年 409 例，而 2000 年为每 1000 人年 161 例；对于 MRI，美国每 1000 人 139 例，而安大略省每 1000 人 13 例；每 1000 人 89 例，美国每 1000 人 62 例；对于超声检查，美国每 1000 人有 495 例，而安大略省每 1000 人有 324 例；超声检查为每 1000 人 580 例，而安大略省为每 1000 人 332 例。随着时间的推移，美国成年人和老年人 CT 成像率的年增长率放缓（从 2000 年至 2006 年，成年人的年增长率为 11.6%，老年人的年增长率为 9.5%，2013 年至 2016 年，成年人的年增长率为 3.7%，老年人的年增长率为 5.2%） 2014-2016 年成人）和 MRI（从 2000-2004 年成人的 11.4% 和 2000-2005 年老年人的 11.3% 增至 2007-2016 年成人的 1.3% 和 2005-2016 年老年人的 2.2%）。安大略省的情况也类似。在儿童中，CT年增长率稳定或下降（美国：从2000-2005年的10.1%降至2013-2016年的0.8%；安大略省：从2000-2006年的3.3%降至2006-2016年的-5.3%），但模式MRI 与成人相似。与 CT 和 MRI 相比，美国和安大略省成人和儿童的超声检查年生长变化较小。2006 年之后，成人和儿童的核医学成像有所下降。结论和相关性从 2000 年到 2016 年，在美国 7 个综合和混合模式医疗保健系统以及安大略省，成人 CT 和 MRI 的使用率持续增加，但速度较慢近年来。在儿童中，除了 CT 之外，影像学检查率持续增加，最近一段时间趋于稳定或下降。观察到的成像利用是否适当或是否与改善患者预后相关尚不清楚。

更新日期：2019-09-03

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