Racial disparities exist in prostate cancer (PCa) care and outcomes. Ultrasound-guided biopsy may miss a significant portion of clinically significant PCa while magnetic resonance imaging (MRI) improves its detection. This study aims to investigate demographic and SES factors influencing MRI utilization for PCa detection.
SEER-Medicare data were used to assess use of pre-diagnostic MRI in 90,908 patients diagnosed with primary PCa (2012-2019). Modified Poisson regression models adjusted for socioeconomic factors such as income, education, Medicare buy-in and dual eligibility were used to examine factors associated with MRI use. All statistical tests were two-sided.
Pre-diagnostic MRI utilization increased substantially between 2012 (3.8%) and 2019 (32.6%). The disparity in utilization between non-Hispanic Black and non-Hispanic White patients decreased by more than half from 43% (RR = 0.57, 95%CI = 0.48-0.67) in 2012 to 20% (RR = 0.80, 95%CI = 0.74-0.86) in 2019. Rural residents were 35% less likely (RR = 0.65, 95%CI = 0.61-0.69) to undergo MRI, while those in the Central US (vs West) were 49% less likely (RR = 0.49, 95%CI = 0.48-0.51). No significant disparities in MRI use were identified between ages ≥75 and 64-75. SES factors associated with MRI were income, education, Medicare buy-in and dual eligibility.
This study revealed increased MRI utilization over time including among those 75 and older. Racial disparities decreased, while wide urban/rural disparities remained. Targeted public health interventions should focus on geographical factors, as "urban/rural designations" and "US region" were associated with the most prominent disparities. Future research should explore pathways contributing to these disparities, using a multidisciplinary approach, including geographical studies, to help eliminate healthcare inequities.
Journal of the National Cancer Institute. 2024 Sep 23 [Epub ahead of print]
Christiane J El Khoury, Stephen J Freedland, Krupa Gandhi, Scott W Keith, Nikita Nikita, Amy Shaver, Swapnil Sharma, Wm Kevin Kelly, Grace Lu-Yao
Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA., Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, USA., Division of Biostatistics and Bioinformatics, Department of Pharmacology, Physiology, and Cancer Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA., Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.