Disparities in the utilization of magnetic resonance imaging for prostate cancer detection: a population-based study

Racial disparities exist in prostate cancer care and outcomes. Ultrasound-guided biopsy may miss a sizeable portion of clinically significant prostate cancer, while magnetic resonance imaging (MRI) improves its detection. This study aimed to investigate demographic and socioeconomic status-related factors influencing MRI use for prostate cancer detection.

Surveillance, Epidemiology, and End Results Program-Medicare data were used to assess use of prediagnostic MRI in 90 908 patients with a diagnosis of primary prostate cancer (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 2 sided.

Prediagnostic MRI use 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% (relative risk [RR] = 0.57, 95% confidence interval [CI] = 0.48 to 0.67) in 2012 to 20% (RR = 0.80, 95% CI = 0.74 to 0.86) in 2019. Rural residents were 35% less likely (RR = 0.65, 95% CI = 0.61 to 0.69) to undergo MRI, while individuals in the US Census Central (vs West) region of the United States were 49% less likely (RR = 0.49, 95% CI = 0.48 to 0.51). No significant disparities in MRI use were identified between individuals 75 years of age and older and individuals aged 64 to 75 years. Socioeconomic status factors associated with MRI use were income, education, Medicare buy-in, and dual eligibility.

This study revealed increased MRI utilization over time, including among individuals 75 years of age and older. Racial disparities decreased, while wide urban-rural disparities remained. Targeted public health interventions should focus on geographical factors because urban or rural designations and US region were associated with the most prominent disparities. Future research should explore pathways contributing to these disparities by using a multidisciplinary approach, including geographical studies, to help eliminate health-care inequities.