Socioeconomics of coronary artery calcium: Is it scored or ignored?

Abstract

Importance: Chicago is one of the most racially segregated cities in the US, with the largest mortality gap between neighborhoods. Computed tomographic coronary artery calcium scoring (CACS) is an excellent risk stratification tool, but costs about $200 out-of-pocket, making it inaccessible to some.

Objective: To determine whether this ACC/AHA guideline-recommended screening tool is accessible to all populations and neighborhoods, we evaluated the price and availability of CACS in Chicago area hospitals.

Design: We used the Illinois Department of Public Health list of area hospitals to inquire about CACS availability and price. We compared these results to US Census Bureau data for each hospital's service area's demographic, ethnic and socioeconomic population characteristics.

Results: Out of the 40 hospitals in Chicagoland, 30 offered CACS. The 10 hospitals without CACS were smaller hospitals in zip codes with a higher population density (p ​< ​0.01), higher poverty rates (22% vs. 13%, p ​< ​0.01), lower percentage of white population (p ​< ​0.02), lower frequency of higher education (35% vs. 51%, p ​< ​0.05), and a trend toward more black residents (p ​< ​0.10). Life expectancy was greater in areas with CACS available (78 vs. 75 years, p ​< ​0.05). Even in areas with CACS, there was wide price variation, with higher prices in poorer areas (r ​= ​0.57, p ​< ​0.01). The highest vs. lowest quintile of income had higher education, larger white population (80% vs. 14%, p ​< ​0.0001), and longer life expectancy (81 vs. 72 years, p ​< ​0.0002), but tended to have a lower price of CACS ($86 vs. $487, p ​< ​0.08).

Conclusions and relevance: CACS is a powerful, evidenced-based clinical tool, but the availability and price vary widely in Chicagoland, and directly correlate with the socioeconomic and health care disparities that are known to exist. Removing these barriers to coronary artery disease screening may be one method to improve the poor cardiovascular outcomes in these areas.

Keywords: Cardiovascular disease screening; Chicago socioeconomic healthcare inequities; Coronary artery calcium scoring; Ethnic disparities.