Utilization of Prediagnostic Prostate Magnetic Resonance Imaging Among Rural Americans: An Analysis of Medicare...

MRI as an initial test for elevated PSA increases the detection of clinically significant prostate cancer while reducing overdiagnosis. Despite its proven benefit, access to MRI in rural areas is limited. Previous studies on utilization of prostate MRI use cancer registries and therefore have limited ability to assess MRI use in the prediagnostic setting. We assess rural/urban disparities in MRI use among Medicare beneficiaries with elevated PSA.

Our sample included Medicare beneficiaries with elevated PSA. The outcome variable was receipt of prostate MRI in the prediagnostic setting. A multivariate logistic regression analysis adjusting for sociodemographic factors and clustered by hospital referral region was performed to test the association between degree of rurality and receipt of MRI.

Among the 1,009,040 beneficiaries with elevated PSA, 4.87% (n = 49,128) obtained an MRI. We observed significant differences in receipt of MRI by degree of rurality. Beneficiaries in the highest population density "metro" centers were more likely to receive an MRI as compared with "urban" or "rural" counties. There were 33% lower odds of obtaining MRI among rural communities compared with metro communities (adjusted OR 0.67; 95% CI: 0.59-0.74; P < .001).

Despite evidence that MRI is an extremely useful tool in the prediagnostic setting, fewer than 1 in 20 beneficiaries in this study received an MRI. Rural patients were less likely than their more urban counterparts to receive MRI for evaluation of elevated PSA. Barriers such as equipment, logistical expertise, and workforce limitations may represent unique challenges for rural patients.