Abdominal pain represents the most common complaint for older people who come to the emergency department, bringing in 1.4 million individuals every year.
Previous research found racial differences in imaging utilization for abdominal pain in one hospital emergency department. A new study confirmed racial differences across the country in what was the first nationwide analysis of this problem, say Penn LDI Senior Fellows Eugenia South, Zachary Meisel, Rachel Kelz, Ari B. Friedman, and colleagues who did the study.
With no clear guidelines, it is up to emergency department doctors to decide how to diagnose the cause of this pain. About 60% of these patients receive a CT scan or an ultrasound as part of their workup, but who are the 40% not getting these comprehensive diagnostic tests?
Compared to white patients of the same age, older Black patients were much less likely to receive definitive diagnostic imaging when they presented to the emergency department with abdominal pain. This was not true for Hispanic and Pacific Islander patients.
Using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2013 to 2020, the team examined 1,656 emergency department visits by adults over age 65 who presented with abdominal pain. Overall, imaging with CT scans and/or ultrasound was performed in 1,073 of these visits (64.7%).
White patients were more likely than Black patients to receive abdominal imaging. Specifically, 67.0% of white patients (802 out of 1,197) received a CT scan or ultrasound, compared to 52.8% of Black patients (124 out of 234), a gap of 14.2 percentage points.
Differing imaging rates may reflect variations in the underlying causes of abdominal pain, or they may suggest that white patients are more likely to receive imaging than is medically necessary. However, given existing evidence that non-white patients generally receive less diagnostic imaging and worse pain care than their white counterparts, this study adds to a growing body of research pointing to racial disparities in emergency department imaging.
The study, “Images in Black and White: Disparities in Utilization of Computed Tomography and Ultrasound for Older Adults with Abdominal Pain” was published February 28, 2025, in Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health. Authors include Ijeoma Unachukwu, Michael N. Adjei-Poku, Olivia C. Sailors, Rachel Gonzales, Eugenia South, Zachary Meisel, Rachel Kelz, Anne Cappola, and Ari B. Friedman.
Author
More on Health Equity
Caring for Disadvantaged Patients: What Nurses Say Works—and What Doesn’t
LDI Fellows Uncover Six Key Barriers and Solutions to Achieving Better Hospital Care
Incarcerated Patients May Not Receive the Surgical Care They Need
The Prison System Often Fails to Meet Even Basic Standards for Pre- and Post-Operative Health, Experts Say
Penn Medicine’s LeadIN Program Trains Philly Teens to Green Their Neighborhoods
Photo & Text Story of an Urban Health Lab Initiative to Improve Health and Community Stability
A Hidden Threat After Cancer: Food Insecurity and Early Death
Food-Insecure Cancer Survivors Live Shorter Lives, Especially if They Can’t Use Federal Programs Like SNAP
HIV is Not a Crime: The Case for Ending HIV Criminalization
Outdated Laws Target Black and Queer Lives in Over 30 States, Fueling a Deadly Disease
LDI and Wharton’s Cynthia Chude Wins 2025 MiFF PhD Scholar Award
Selected for Current and Future Research in the Science of Amputee Care