A health disparities research framework to guide a radiology response to achieve equitable care during crisis


      • Public health crises like the COVID-19 pandemic can exacerbate existing health disparities related to social determinants of health.
      • Radiology departments have a central role in mitigating emerging health disparities exacerbated during crises, like the COVID-19 pandemic.
      • Our response can be enhanced using the modified health disparity research framework (HDRF): Detecting, Understanding, Reducing, Evaluating.
      • This modified HDRF can aid in ensuring that a rapid response to crisis is also an equitable response for those most vulnerable.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Institute of Medicine
        Unequal treatment: confronting racial and ethnic disparities in health care.
        The National Academies Press, Washington, DC.2003
        • Rudowitz R.
        • Rowland D.
        • Shartzer A.
        Health care in New Orleans before and after hurricane Katrina: the storm of 2005 exposed problems that had existed for years and made solutions more complex and difficult to obtain.
        Health Aff. 2006; 25: 393-406
        • Sirotich E.
        • Hausmann J.S.
        Removing barriers and disparities in health: lessons from the COVID-19 pandemic.
        Nat Rev Rheumatol. Oct 7 2020; ([Internet]) (Available from:): 1-2
        • Centers for Disease Control and Prevention
        (Available from:)Health Equity Considerations & Racial & Ethnic Minority Groups (Updated July 24, 2020). 2019. 2020: 18-21
        • Office M of B
        COVID-19 health inequity task force report. 2020: 1-9
        • Williams D.R.
        • Cooper L.A.
        COVID-19 and health equity—a new kind of “herd immunity.”.
        JAMA. Jun 23 2020; 323 (Available from:): 2478
      1. Economic Policy Institute. Black workers face two of the most lethal preexisting conditions for coronavirus—racism and economic inequality. Econ Policy Inst [Internet]. Available from:

        • Madhuripan N.
        • Cheung H.M.C.
        • Alicia Cheong L.H.
        • Jawahar A.
        • Willis M.H.
        • Larson D.B.
        Variables influencing radiology volume recovery during the next phase of the coronavirus disease 2019 (COVID-19) pandemic.
        J Am Coll Radiol. 2020; 17 ([Internet]. Available from:): 855-864
        • Mossa-Basha M.
        • Meltzer C.C.
        • Kim D.C.
        • Tuite M.J.
        • Kolli K.P.
        • Tan B.S.
        Radiology department preparedness for COVID-19: radiology scientific expert panel.
        Radiology. Mar 16 2020; 80 (Available from:)200988
        • Nápoles A.M.
        • Stewart A.L.
        Transcreation: an implementation science framework for community-engaged behavioral interventions to reduce health disparities.
        BMC Health Serv Res. 2018; 18: 1-15
        • Thomas S.B.
        • Quinn S.C.
        • Butler J.
        • Fryer C.S.
        • Garza M.A.
        Toward a fourth generation of disparities research to achieve health equity.
        Annu Rev Public Health. 2011; 32: 399-416
        • Kilbourne A.M.
        • Switzer G.
        • Hyman K.
        • Crowley-Matoka M.
        • Fine M.J.
        Advancing health disparities research within the health care system: a conceptual framework.
        Am J Public Health. 2006; 96: 2113-2121
        • Chinman M.
        • Woodward E.N.
        • Curran G.M.
        • LRM Hausmann
        Harnessing implementation science to increase the impact of health equity research.
        Med Care. Sep 2017; 55 (Available from:)
        • Glasgow R.E.
        • Harden S.M.
        • Gaglio B.
        • Rabin B.
        • Smith M.L.
        • Porter G.C.
        RE-AIM planning and evaluation framework: adapting to new science and practice with a 20-year review.
        Front Public Heal. Mar 29 2019; 7 (Available from:)
        • Chonde D.B.
        • Pourvaziri A.
        • Williams J.
        • McGowan J.
        • Moskos M.
        • Alvarez C.
        RadTranslate: an artificial intelligence–powered intervention for urgent imaging to enhance care equity for patients with limited English proficiency during the COVID-19 pandemic.
        J Am Coll Radiol. 2021; ([Internet]) (Available from:)
        • Betancourt J.R.
        • Tan-McGrory A.
        • Flores E.
        • López D.
        Racial and ethnic disparities in radiology: a call to action.
        J Am Coll Radiol. 2019; 16 ([Internet]) (Available from:): 547-553
      2. Coronavirus Disease 2019 (COVID-19) Cases in MA.
        Massachusetts Dep Public Heal, April 22, 2020
        • Alvidrez J.
        • Castille D.
        • Laude-Sharp M.
        • Rosario A.
        • Tabor D.
        The National Institute on Minority Health and Health Disparities research framework.
        Am J Public Health. 2019; 109: S16-S20
        • Cole M.B.
        • Wright B.
        • Wilson I.B.
        • Galárraga O.
        • Trivedi A.N.
        Longitudinal analysis of Racial/Ethnic trends in quality outcomes in community health centers, 2009–2014.
        J Gen Intern Med. 2018; 33: 906-913
        • Burke J.G.
        • Hess S.
        • Hoffmann K.
        • Guizzetti L.
        • Loy E.
        • Gielen A.
        • et al.
        Translating community-based participatory research (CBPR) principles into practice: building a research agenda to reduce intimate partner violence.
        Prog Community Heal Partnersh. 2014; 7: 115-122
        • Lyles C.
        • Schillinger D.
        • Sarkar U.
        Connecting the dots: health information technology expansion and health disparities.
        PLoS Med. 2015; 12: 3-7
      3. 2020; 2–3.

        • Brown A.F.
        • Ma G.X.
        • Miranda J.
        • Eng E.
        • Castille D.
        • Brockie T.
        • et al.
        Structural interventions to reduce and eliminate health disparities.
        Am J Public Health. 2019; 109: S72-S78