Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Hansen, NF; Zurl, H; Korn, SM; Zhang, J; Tan, HJ; Nielsen, ME; Moore, CM; Trinh, QD; Kibel, AS; Cole, AP.
Utilization of Pre-Diagnostic Prostate MRI Among Rural Americans: An Analysis of Medicare Claims for Elevated PSA.
Urol Pract. 2025; 101097UPJ0000000000000956
Doi: 10.1097/UPJ.0000000000000956
PubMed
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- Zurl Hanna
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- Abstract:
- INTRODUCTION AND OBJECTIVES: MRI as an initial test for elevated PSA increases detection of clinically significant prostate cancer while reducing overdiagnosis. Despite its proven benefit, access to MRI in rural areas is limited. Prior studies on utilization of prostate MRI use cancer registries and therefore have limited ability to assess MRI use in the pre-diagnostic setting. We assess rural/urban disparities in MRI use among Medicare beneficiaries with elevated PSA. MATERIALS & METHODS: Our sample included Medicare beneficiaries with elevated PSA. The outcome variable was receipt of prostate MRI in the pre-diagnostic setting. A multivariate logistic regression analysis adjusting for sociodemographic factors and clustered by hospital referral region (HRR) was performed to test the association between degree of rurality and receipt of MRI. RESULTS: Amongst the 1,009,040 beneficiaries with elevated PSA, 4.87% (n=49,128) obtained an MRI. We observed significant differences in receipt of MRI by degree of rurality. Beneficiaries in the highest population density "metro" centers were more likely to receive an MRI as compared to "urban" or "rural" counties. There was 33% lower odds of obtaining MRI among "rural" communities compared to "metro" communities (aOR 0.67; 95% CI 0.59-0.74; p<0.001). CONCLUSION: Despite evidence that MRI is an extremely useful tool in the pre-diagnostic setting, fewer than 1 in 20 beneficiaries in this studied received an MRI. Rural patients were less likely than their more urban counterparts to receive MRI for evaluation of elevated PSA. Barriers such as equipment, logistical expertise and workforce limitations may represent unique challenges for rural patients.