Study finds geographic disparities in MRI use in prostate cancer

Although MRI utilization in prostate cancer has increased over time, urban-rural and regional disparities still persist, according to findings from a recent study.¹

Racial disparities, on the other hand, appear to be narrowing.

Patients in rural areas were 35% less likely to undergo pre-diagnostic MRI compared with those residing in urban areas.

The study was conducted by investigators at Thomas Jefferson University, and the findings were published in Journal of the National Cancer Institute.

“According to clinical guidelines, MRI is better at identifying cancers and has been increasingly used over the past decade,” explained lead author Christiane El Khoury, PharmD, an assistant director of cancer research administration at Thomas Jefferson, in a news release on the findings.²

For the study, the investigators retrospectively assessed the use of pre-diagnostic MRI across 90,908 patients who received a diagnosis of primary prostate cancer from 2012 to 2019. The data were collected from the Surveillance, Epidemiology, and End Results Program-Medicare linked database. According to the authors, “exposure to pre-diagnostic MRI was defined as having had at least 1 Medicare claim for an MRI ordered 6 months before prostate cancer diagnosis and during the month of diagnosis (total duration of 7 months).”

Overall, data showed an increase in MRI utilization over the time assessed, including among patients aged 75 and older. In 2012, the use of pre-diagnostic MRI among all patients was 3.8%, which increased to 32.6% in 2019.

Increases were also observed among both non-Hispanic White and non-Hispanic Black patients. Specifically, use of MRI among non-Hispanic Black patients increased from 2.5% in 2012 to 24.7% in 2019. Similarly, MRI use among non-Hispanic White patients increased from 4.0% in 2012 to 33.3% in 2019. This translates to an approximately 10-fold increase in MRI utilization in non-Hispanic Black patients and an approximately 8-fold increase in non-Hispanic White patients over the study period.

When comparing utilization between these 2 groups, the investigators observed racial disparities, though they decreased over the study period. In 2012, non-Hispanic Black patients were 43% less likely to receive pre-diagnostic MRI compared with non-Hispanic White patients (RR, 0.57; 95% CI, 0.48-0.67), which was nearly halved to 20% (RR, 0.80; 95% CI, 0.74-0.86) in 2019.

MRI uptake increased among all racial groups in both rural and urban settings. In urban areas, MRI utilization in 2019 reached 26.3% among non-Hispanic Black patients and 46.6% among non-Hispanic White patients. Similarly, in rural areas, MRI use in 2019 reached 11.2% in non-Hispanic Black patients and 17.7% in non-Hispanic White patients.

However, disparities persisted when comparing utilization by geographic regions. Compared with urban patients, those living in rural areas were 35% less likely to undergo pre-diagnostic MRI (RR, 0.65; 95% CI, 0.61-0.69). Similarly, patients residing in the US Census Central region of the US were 49% less likely to undergo MRI compared with patients residing in the Western region of the US (RR, 0.51; 95% CI, 0.48-0.55).

There were no significant differences observed in MRI utilization between patients aged 64 to 75 years and those aged 75 years or older. The investigators did note an association between MRI use and measures of socioeconomic status such as income, education, Medicare buy-in (RR, 0.72; 95% CI, 0.60-0.87), and dual eligibility (RR, 0.80; 95% CI, 0.69-0.93).

Based on these findings, the authors concluded, “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.”

REFERENCES
1. El Khoury CJ, Freedland SJ, Gandhi K, et al. Disparities in the utilization of magnetic resonance imaging for prostate cancer detection: a population-based study. J Natl Cancer Inst. 2025;117(2):270-278. doi:10.1093/jnci/djae234

2. Disparities in use of MRI to detect prostate cancer. News release. Thomas Jefferson University. March 25, 2025. Accessed March 27, 2025. https://www.eurekalert.org/news-releases/1078128