Sociodemographic, structural processes mostly explain racial disparity in prostate MRI use
Click Here to Manage Email Alerts
Sociodemographic factors and products of structural racism, such as poverty and residential segregation, explained most of the racial disparity observed in use of prostate MRI among older Black men and white men with prostate cancer.
Results of mediation analyses in the population-based cohort study, published in in JAMA Oncology, can be applied to develop targeted strategies to improve cancer care equity, researchers wrote.
"Clinicians and health care institutions should be aware that racial disparities exist and are pronounced in access to cutting-edge health care services that are part of the cancer diagnosis,” Michael S. Leapman, MD, assistant professor of urology and clinical program leader in the prostate and urologic cancers program at Yale Cancer Center, told Healio. “One straightforward strategy that could be implemented would be to track how new and established tools are utilized. Greater insight into these patterns by physicians can help improve the equity with which new tools are used.”
Background and methodology
Black men have considerably higher lifetime risks for prostate cancer diagnosis and death than white men, and prostate MRI has been shown to improve initial diagnosis and can more accurately show the stage of the disease, Leapman said.
“Although the causes for this disparity are not fully understood, earlier detection and high-quality treatment are linked with better outcomes for the disease,” Leapman said. “From that perspective, we should be on the lookout for gaps in access to tools and services that can help identify potentially lethal cancers at an earlier stage.”
The analysis included 39,534 men (mean age, 72.8 years, standard deviation, 5.3 years; 10.1% Black, 82.4% white) from the SEER database diagnosed with localized prostate cancer from 2011 to 2015.
Leapman and colleagues assessed claims for prostate MRI within 6 months before or after diagnosis of prostate cancer, identified candidate clinical and sociodemographic meditators based on association with both race and prostate MRI, and performed meditation analyses to estimate the direct and indirect effects of mediators.
Key findings
Results showed Black men with prostate cancer were less likely than white men to receive a prostate MRI (6.3% vs. 9.9%; unadjusted OR = 0.62; 95% CI, 0.54-0.7). Further analyses revealed the racial disparity in prostate MRI use between Black and white patients as attributable to:
geographic differences (24%; 95% CI, 14-32);
neighborhood-level socioeconomic status, specifically residence in a high-poverty area (19%; 95% CI, 11-28);
racialized residential segregation, specifically Index of Concentration at the Extremes quintile (19%; 95% CI, 10-29); and
a marker of individual-level socioeconomic status — dual eligibility for Medicare and Medicaid (11%; 95% CI, 7-16).
Leapman and colleagues reported the identified mediators accounted for 81% (95% CI, 64-98) of the observed racial disparity in prostate MRI use between Black and white patients.
Implications
The results highlight the need for strategies to improve access to new diagnostic technologies, Leapman said, including a wider focus on the social, demographic and structural contexts through which cancer care is delivered.
“Racial disparity in the use of prostate MRI does not exist in a vacuum,” Leapman told Healio. “We found that racial disparity in prostate MRI use was connected with other major drivers of health care inequalities, such as what region you live in — living in an affluent or poor or more racially segregated neighborhood.”
As new technologies become the standard of care, “racially marginalized populations are left at the wayside” due to “a long history of discrimination that continues to preclude them from resources important in their care,” Michael Poulson, MD, MPH, resident physician and research fellow in general surgery at Boston University School of Medicine and Boston Medical Center, wrote in an accompanying editorial.
“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 wrote. “Not all solutions to health care disparities are solved in the hospital. Many must come from changes to the societal structure in which we all live.”
References:
- Leapman MS, et al. JAMA Oncol. 2022;doi:10.1001/jamaoncol.2021.8116.
- Poulson M. JAMA Oncol. 2022;doi:10.1001/jamaoncol.2021.7271.
For more information:
Michael S. Leapman, MD, can be reached at Department of Urology, Yale School of Medicine, 310 Cedar St., BML 238c, New Haven, CT 06520; email: michael.leapman@yale.edu.
Collapse
Click Here to Manage Email Alerts