Christiane J El Khoury, Stephen J Freedland, Krupa Gandhi, Scott W Keith, Nikita Nikita, Amy Shaver, Swapnil Sharma, W M Kevin Kelly, Grace Lu-Yao
{"title":"利用磁共振成像检测前列腺癌的差异：基于人群的研究。","authors":"Christiane J El Khoury, Stephen J Freedland, Krupa Gandhi, Scott W Keith, Nikita Nikita, Amy Shaver, Swapnil Sharma, W M Kevin Kelly, Grace Lu-Yao","doi":"10.1093/jnci/djae234","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":14809,"journal":{"name":"JNCI Journal of the National Cancer Institute","volume":" ","pages":"270-278"},"PeriodicalIF":9.9000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807436/pdf/","citationCount":"0","resultStr":"{\"title\":\"Disparities in the utilization of magnetic resonance imaging for prostate cancer detection: a population-based study.\",\"authors\":\"Christiane J El Khoury, Stephen J Freedland, Krupa Gandhi, Scott W Keith, Nikita Nikita, Amy Shaver, Swapnil Sharma, W M Kevin Kelly, Grace Lu-Yao\",\"doi\":\"10.1093/jnci/djae234\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":14809,\"journal\":{\"name\":\"JNCI Journal of the National Cancer Institute\",\"volume\":\" \",\"pages\":\"270-278\"},\"PeriodicalIF\":9.9000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807436/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JNCI Journal of the National Cancer Institute\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/jnci/djae234\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JNCI Journal of the National Cancer Institute","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/jnci/djae234","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
Disparities in the utilization of magnetic resonance imaging for prostate cancer detection: a population-based study.
Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
期刊介绍：
The Journal of the National Cancer Institute is a reputable publication that undergoes a peer-review process. It is available in both print (ISSN: 0027-8874) and online (ISSN: 1460-2105) formats, with 12 issues released annually. The journal's primary aim is to disseminate innovative and important discoveries in the field of cancer research, with specific emphasis on clinical, epidemiologic, behavioral, and health outcomes studies. Authors are encouraged to submit reviews, minireviews, and commentaries. The journal ensures that submitted manuscripts undergo a rigorous and expedited review to publish scientifically and medically significant findings in a timely manner.
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