Structural racism causes disparities in prostate MRI use

2021 01 16 00 14 5464 Prostate Cancer 400

Structural racism causes disparities in the use of MRI among Black and white men diagnosed with prostate cancer, with Black men less likely to get scans, according to research published March 3 in JAMA Oncology.

The findings underscore the importance of facing the reality of racism in the U.S. head-on, wrote a team led by Dr. Michael Leapman of Yale School of Medicine in New Haven, CT.

"Strategies to reduce race-based [healthcare] inequalities begin with broader acknowledgment of their existence and the processes that underlie their perpetuation," the authors wrote.

Racial disparities in the diagnosis, treatment, and outcomes of men with prostate cancer are baked into the U.S. healthcare system, Leapman and colleagues noted. Black men are more likely to be diagnosed with prostate cancer and are at nearly twice the risk of dying of the disease compared with their white counterparts.

These differences are not due to physical factors, the authors wrote.

"Recent analyses suggest that observed racial disparities in prostate cancer outcomes are wholly or, at least in part, attributable to factors that are associated with race, but only through generations of the legal, social, and medical (i.e., 'structural') disadvantages experienced by Black persons in the U.S. and are not the result of immutable biological differences," they wrote.

Leapman's group sought to investigate what contributes to healthcare inequity when it comes to the use of prostate MRI in men diagnosed with the disease. The team conducted a study that included information taken from the U.S. Surveillance, Epidemiology, and End Results (SEER) Medicare database for 39,534 patients with a diagnosis of prostate cancer between January 2011 and December 2015.

Black patients made up 10.1% of the study cohort, while white patients represented 82.4%; mean age was 72.8 years. The authors tracked claims for prostate MRI exams within six months before or after the men were diagnosed and assessed clinical and sociodemographic factors among patients.

The use of prostate MRI in patients diagnosed with prostate cancer increased over the study period, from 5.3% in 2011 to 17.5% in 2015. But still, Black patients diagnosed with prostate cancer were indeed less likely to undergo prostate MRI than their white counterparts:

Impact of race on likelihood of undergoing prostate MRI scans
Measure White patients Black patients
Likelihood of receiving prostate MRI after diagnosis 9.9% 6.3%

The team also found the following regarding racial disparities in the use of prostate MRI:

  • 24% of disparities were due to geographic differences.
  • 19% were attributable to neighborhood-level socioeconomic status (i.e., residence in a high-poverty area).
  • 19% were due to what the team termed "racialized residential segregation."
  • 11% were attributable to individual-level socioeconomic status (i.e., eligibility for both Medicare and Medicaid).

Clinical and pathologic factors didn't appear to influence the use of prostate MRI among Black and white patients, the team noted.

More disturbingly, cancer risk didn't appear to mitigate racial disparity in use of prostate MRI, "underscoring that the factors associated with imaging use are largely not related to the characteristics of the patient's disease," Leapman and colleagues wrote.

Addressing inequities such as the use of prostate MRI for men diagnosed with prostate cancer demands a comprehensive approach, according to an accompanying commentary written by Dr. Michael Poulson of Boston University School of Medicine.

"Prostate cancer survival depends on accurate diagnosis and treatment," he wrote. "With emerging technologies becoming standard of care, racially marginalized populations are left at the wayside ... because of the long history of discrimination that continues to preclude them from resources important in their care ... 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."

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