Association of area of deprivation index with magnetic resonance imaging (MRI) utilization for prostate cancer detection: results from a contemporary North American population.

Abstract

Purpose: Since the use of Magnetic Resonance Imaging (MRI) in the initial diagnostic evaluation for prostate cancer (PCa) has considerable costs, there is concern that socioeconomic barriers may result in MRI underutilization. We examined the relationship between socioeconomic factors, measured by the Area Deprivation Index (ADI), and MRI utilization in PCa diagnostic setting using a contemporary North American population.

Methods: We included all the patients aged > 40 years with a confirmed PSA > 3 ng/mL at Henry Ford Health (HFH) between 2018 and 2022. An ADI score was assigned to each patient based on their residential census block group, ranked as a percentile of deprivation relative to the national level. The higher the ADI, the more the area has a socio-economic disadvantage. MRI and biopsy status were defined as undergoing these procedures within 6 and 9 months, respectively, from their first PSA > 3 ng/mL in the time period. Univariable (UVA) and multivariable (MVA) Logistic regression models tested the impact of ADI on prostate MRI or biopsy utilization.

Results: We included 18,827 patients who had a PSA > 3 ng/mL, 3759 (20%) of whom were Non-Hispanic Black. Overall, 679 (3.6%) and 1672 (8.8%) of these individuals underwent prostatic MRI and prostate biopsy, respectively. Median (IQR) age and ADI percentile were 68 (62-74) years and 58 (38-79), respectively. Patients who received MRI were more likely to be younger (66 vs. 68, p = 0.006), Non-Hispanic Black [28.0% (95%CI: 24.7%-31.5%) vs. 19.7% (95% CI 19.1%-20.3%), p < 0.0001] and to undergo PSA test in more recent median years (2021 vs. 2019, p < 0.0001), compared to those who did not undergo MRI. When stratifying the population by ADI quintiles, men in the fifth (most deprived) quintile were less likely to receive MRI (3.1% vs. 5.9%, p < 0.001), compared to those in the first (most affluent) quintile. At logistic MVA, patients living in more deprived neighborhoods (higher ADI percentile) were less likely to receive MRI before PCa diagnosis (OR: 0.90, p < 0.001). Specifically, for an increase in ADI percentile of 10 units, the relative odds of receiving MRI decreased by 10%.

Conclusions: Although the overall utilization of prostate MRI remains low in this real-world study, men living in more socioeconomically deprived areas were significantly less likely to undergo MRI before PCa diagnosis. Our findings underscore the need for targeted interventions to ensure a more equitable access to advanced diagnostic tools.