Distance and Likelihood of Cardiovascular Imaging Receipt Among Medicare Beneficiaries: Cardiovascular Imaging Deserts Among Medicare Beneficiaries

Background: It is unclear whether geographic distance to a cardiovascular imaging center (CVIC) is associated with receipt of cardiovascular imaging (CVI). Objectives: This study sought to assess temporal trends in distance to a CVIC and examine the relationship of distance to a CVIC and receipt of CVI overall and by modality. Methods: Among 64,260,530 older U.S. Medicare fee-for-service and Medicare Advantage beneficiaries from 2018 to 2021, the study measured individual distances to the nearest CVIC. Poisson regression was used to evaluate the likelihood of receipt of CVI as a function of distance, overall and by modality. Results: Of those beneficiaries included (age: 73.0 ± 8 years; 54.6% female; 80.1% White), 17.5% underwent CVI. The number of CVICs increased (0.02% per year), but median distances to CVICs remained stable (3.3-3.4 miles). Compared with beneficiaries living 10 to 16 miles from a CVIC, distance >16 miles from a CVIC was associated with lower likelihood of receipt (rate ratio: 0.957 [95% CI: 0.956-0.959]; P < 0.001). The lowest likelihood of receipt was within 10 miles of services (rate ratio: 0.923 [95% CI: 0.921-0.924]; P < 0.001). Distances to cardiac computed tomography (CCT), cardiac magnetic resonance (CMR), and positron emission tomography (PET) services were longer than distances to echocardiography and single-photon emission computed tomography (SPECT) services: (median distance: CCT: 8.1 miles [Q1-Q3: 3.7-21.3 miles]; CMR: 17.4 miles [Q1-Q3: 7.3-43.3 miles]; and PET: 88.9 miles [Q1-Q3: 26.2-194.6 miles] vs echocardiography: 3.4 miles [Q1-Q3: 0.4-7.0 miles]; and SPECT: 3.8 miles [Q1-Q3: 1.3-7.9 miles]). Conclusions: From 2018 to 2021, the number of CVICs increased, although distances to CVICs remained stable. The lowest likelihood receipt of imaging overall was among those patients living within 10 miles of a CVIC, a finding suggesting that proximity is insufficient for access. CCT, CMR, and PET services were concentrated in large metropolitan academic centers.