S. J. Baker1, C. Baletine1, R. Xie1, H. Edenfield1, H. Chen1 1University Of Alabama,Surgery,Birmingham, AL, USA
Introduction: Laboratory screening and identification of pathology at earlier stages can prevent disease progression, reduce surgical risks, and potentially improve overall outcome. Despite the potential benefits of early screening, the effectiveness is dependent upon the disease incidence and the availability of the test. Lack of access to care restricts early screening in certain socially disadvantaged populations. This study examined disparities in routine serum calcium screening and the incidence of hypercalcemia within a health system where racial minority groups are adequately represented.
Methods: : All patients at a large academic health center with several hospitals and outpatient clinics during 2011-2015 were included. Demographic and laboratory data in the Electronic Medical Record (EMR) systems were analyzed to assess the calcium screening rates and incidence of hypercalcemia by age, gender, race, and insurance type. One way frequency, chi-square test of independence and multivariable analyses were conducted.
Results: In this 5 year period, 1,302,802 patients were evaluated, including 379,021 African Americans (28%), 20,398 Hispanics (2%), 13,022 Asians (1%), 762,915 Caucasians (59%), and 127,446 other ethnicities (10%). Of these patients, 577,994 (48%) had at least one serum calcium level recorded. Older age, male, black, and covered by Medicare are significantly associated with higher calcium screening rates. The screening rate in patients older than 65 was 57% versus 45% ( in their counterpart. Males had higher screening rate than female (51% vs. 46%). African Americans were more likely to have a serum calcium level drawn (52%) versus Caucasians (48%), Asians (44%), and Hispanics (35%;). In addition, patients with Medicare were most likely to have calcium level screening (56%), followed by private insurance (48%), Medicaid (34%), and uninsured (20%). The overall incidence of hypercalcemia was 2.2%, ranging from 0.9% in Asian males to 2.8% in African American females (see Table).
Conclusion: Significant disparities in laboratory testing exist within a large population cohort. Despite this, the incidence of hypercalcemia is relative low, suggesting that routine screening of any group of patients is likely not cost effective.
