Background 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. Methods 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. Results 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. Conclusions 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.

中文翻译：

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MRI 在前列腺癌检测中的应用差异：一项基于人群的研究


背景 前列腺癌 (PCa) 护理和结果存在种族差异。超声引导活检可能会漏掉临床上重要的前列腺癌的很大一部分，而磁共振成像 (MRI) 则可以改善其检测。本研究旨在调查影响 MRI 用于 PCa 检测的人口统计学和 SES 因素。方法 SEER-Medicare 数据用于评估 2012-2019 年诊断为原发性 PCa 的 90,908 名患者的诊断前 MRI 的使用情况。根据收入、教育、医疗保险购买和双重资格等社会经济因素调整的修正泊松回归模型用于检查与 MRI 使用相关的因素。所有统计检验都是双面的。结果 2012 年 (3.8%) 至 2019 年 (32.6%) 期间，诊断前 MRI 利用率大幅增加。非西班牙裔黑人和非西班牙裔白人患者之间的利用率差异减少了一半以上，从 2012 年的 43%（RR = 0.57，95%CI = 0.48-0.67）下降到 20%（RR = 0.80，95%CI = 2019 年，农村居民接受 MRI 的可能性降低了 35%（RR = 0.65，95%CI = 0.61-0.69），而美国中部（相对于西部）的居民接受 MRI 的可能性降低了 49%（RR = 0.49） ，95%CI = 0.48-0.51）。 ≥75 岁和 64-75 岁之间的 MRI 使用没有显着差异。与 MRI 相关的社会经济地位因素包括收入、教育、医疗保险购买和双重资格。结论 这项研究表明，随着时间的推移，MRI 的使用率不断增加，其中包括 75 岁及以上的老年人。种族差距缩小，但城乡差距依然存在。有针对性的公共卫生干预措施应侧重于地理因素，因为“城市/乡村名称”和“美国地区”与最显着的差异相关。 未来的研究应该探索导致这些差异的途径，使用包括地理研究在内的多学科方法，以帮助消除医疗保健不平等。