TY - JOUR
T1 - Rates, costs and determinants of lumbar spine imaging in population-based women born in 1973-1978: Data from the Australian Longitudinal Study on Women's Health
AU - Wang, Yuanyuan
AU - Hussain, Sultana Monira
AU - Wluka, Anita E
AU - Lim, Yuan Z
AU - Urquhart, Donna M
AU - Mishra, Gita D
AU - Teede, Helena
AU - Doust, Jenny
AU - Brown, Wendy J
AU - Cicuttini, Flavia M
N1 - Funding Information:
The Australian Longitudinal Study on Women?s Health is funded by the Australian Government Department of Health and Ageing (https://www.health.gov.au/) (GDM). The current linkage study is further supported by the Alfred Foundation (https://www.alfredhealth.org.au/thealfred-foundation) (FMC, SMH) and Medical Research Future Fund (https://www.health.gov.au/ initiatives-and-programs/medical-research-future-fund) (DMU, FMC, HT, GDM). YW and AEW are the recipients of National Health and Medical Research Council (NHMRC, https://www.nhmrc.gov.au/) Translating Research into Practice Fellowship (APP1168185 and APP1150102, respectively). SMH is the recipient of NHMRC Early Career Fellowship (APP1142198). YZL is the recipient of NHMRC Clinical Postgraduate Scholarship (APP1133903), Royal Australasian College of Physicians Woolcock Scholarship, Australian Rheumatology Association Top-Up Scholarship and Monash University Postgraduate Excellence Award. DMU is the recipient of NHMRC Career Development Fellowship (Clinical Level 2, APP1142809). GDM is the recipient of NHMRC Principal Research Fellowship (APP1121844). HT is the recipient of NHMRC Practitioner Fellowship (APP1942516). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The research on which this paper is based was conducted as part of the Australian Longitudinal Study on Women?s Health by the University of Queensland and the University of Newcastle. We are grateful to the women who provided the survey data.
Publisher Copyright:
© 2020 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2020/12/3
Y1 - 2020/12/3
N2 - OBJECTIVE: There are concerns that lumbar spine imaging represents low value care. Our aim was to examine the use of lumbar spine imaging [radiography, computed tomography (CT), magnetic resonance imaging (MRI)] over 20 years, and costs and person-level characteristics of imaging in a large cohort of Australian women.METHODS: The Australian Longitudinal Study on Women's Health (ALSWH) is a longitudinal population-based survey of women randomly selected from national health insurance scheme (Medicare) database. This study examined 13458 women born in 1973-1978 who consented to link their ALSWH and Medical Benefits Scheme records. Self-reported data on demographics, body mass index, depression, physical and mental health, and back pain were collected in each survey performed in 1996, 2000, 2003, 2006, 2009, 2012, and 2015. Data on lumbar spine imaging from 1996 to 2015 were obtained from the Medical Benefits Scheme database.RESULTS: 38.9% of women underwent some form of lumbar spine imaging over 20 years. While radiography increased from 1996 to 2011 and decreased thereafter, CT and MRI continued to increase from 1996 to 2015. In women with self-reported back pain, depression and poorer physical health were associated with imaging, with no significant differences in types of imaging. Based on imaging rates in ALSWH, the estimated costs for Australian women aged 30-39 years were AU$51,735,649 over 2011-2015.CONCLUSIONS: Lumbar spine imaging was common in population-based Australian women, with rates increasing over 20 years. Depression and poor physical health were associated with lumbar spine imaging. Raising awareness of this in clinicians is likely to result in significant cost savings if clinical guidelines are followed, with the potential of freeing resources for high value care and health outcomes.
AB - OBJECTIVE: There are concerns that lumbar spine imaging represents low value care. Our aim was to examine the use of lumbar spine imaging [radiography, computed tomography (CT), magnetic resonance imaging (MRI)] over 20 years, and costs and person-level characteristics of imaging in a large cohort of Australian women.METHODS: The Australian Longitudinal Study on Women's Health (ALSWH) is a longitudinal population-based survey of women randomly selected from national health insurance scheme (Medicare) database. This study examined 13458 women born in 1973-1978 who consented to link their ALSWH and Medical Benefits Scheme records. Self-reported data on demographics, body mass index, depression, physical and mental health, and back pain were collected in each survey performed in 1996, 2000, 2003, 2006, 2009, 2012, and 2015. Data on lumbar spine imaging from 1996 to 2015 were obtained from the Medical Benefits Scheme database.RESULTS: 38.9% of women underwent some form of lumbar spine imaging over 20 years. While radiography increased from 1996 to 2011 and decreased thereafter, CT and MRI continued to increase from 1996 to 2015. In women with self-reported back pain, depression and poorer physical health were associated with imaging, with no significant differences in types of imaging. Based on imaging rates in ALSWH, the estimated costs for Australian women aged 30-39 years were AU$51,735,649 over 2011-2015.CONCLUSIONS: Lumbar spine imaging was common in population-based Australian women, with rates increasing over 20 years. Depression and poor physical health were associated with lumbar spine imaging. Raising awareness of this in clinicians is likely to result in significant cost savings if clinical guidelines are followed, with the potential of freeing resources for high value care and health outcomes.
UR - http://www.scopus.com/inward/record.url?scp=85097123769&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0243282
DO - 10.1371/journal.pone.0243282
M3 - Article
C2 - 33270739
SN - 1932-6203
VL - 15
JO - PLoS One
JF - PLoS One
IS - 12
M1 - e0243282
ER -
