Understanding the structural factors that fuel racial disparities in the use of prostate MRI
A new JAMA Oncology analysis unearths some of the key factors fueling racial disparities in the delivery of prostate MR imaging.
Previous studies have explored this phenomenon, with Black men experiencing a twofold greater risk of cancer-related mortality from this form of the disease when compared to white men. Yale University experts recently set out to better understand, analyzing claims data from nearly 40,000 individuals.
They found that Black men with localized prostate cancer were significantly less likely to receive a related MRI in the period after diagnosis, with clues on how to begin closing care gaps.
“Our results can help to inform focused efforts to improve equitable access and quality of diagnostic cancer imaging,” corresponding author Michael Leapman, MD, with the Department of Urology at the Yale School of Medicine, and co-authors wrote March 3. “Greater access to prostate MRI has been championed by practice organizations, such as the American Urological Association, the American College of Radiology, and patient advocacy groups to improve the quality and precision of prostate cancer care; however, tangible plans for action are undefined.”
Scientists gathered their information from the U.S. Surveillance, Epidemiology, and End Results (SEER)–Medicare database, encompassing 39,534 men diagnosed with localized prostate cancer between 2011-2015. Leapman et al. also analyzed claims for the six months before and after diagnosis. The study population included a total of nearly 4,000 Black patients (10%) and almost 33,000 white ones (82%), at an average age of 73. The former were less likely to receive a prostate MRI than the latter (about 6% vs 10%), with an unadjusted odds ratio of 0.62.
About 24% of the disparity between Black and white patients was tied to geographic differences, Leapman et al. wrote. Other reasons included neighborhood-level socioeconomic status (19%), racialized residential segregation (19%), and individual-level socioeconomic status (11%). The research team also found that clinical and pathologic factors were not significant mediators of imaging disparities.
In a corresponding editorial, physician Michael Poulson, MD, said this work can serve as a model for addressing imaging inequalities “in the context of the discriminatory landscape from which they were built.”
“Solutions to racial disparities are attainable through actionable reparative actions aimed at righting the wrongs of history and narrowing the racial wealth gaps created by the discriminatory history of the U.S.,” Poulson, with the Department of Surgery at Boston Medical Center, wrote March 3. “Not all solutions to healthcare disparities are solved in the hospital. Many must come from changes to the societal structure in which we all live.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.