Disparities in the Utilization of MRI for Prostate Cancer Detection: A Population-Based Study

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.