Race-insurance disparities in prostate patients' magnetic resonance imaging biopsies and their subsequent cancer care: a New York State cohort study.

For organ-confined prostate cancer, socioeconomic factors influencing Magnetic Resonance Imaging (MRI)-guided biopsy utilization and downstream prostate cancer patients' care are unknown. This retrospective, observational cohort study used the New York Statewide Planning and Research Cooperative System (SPARCS) billing-code driven database to examine the impact of prostate patients' socioeconomic characteristics on prostate cancer care defined as initial biopsy, 2-month post-biopsy cancer diagnoses, and within 1-year cancer-related intervention, controlling for other risk factors. From 2011-2017, the population studied (n = 18,253) included all New York State-based, male, residents aged 18 to 75 without a prior prostatectomy receiving a first-time biopsy; 760 such patient records in 2016 were removed due to data quality concerns. Major exposures included patient age, race, ethnicity and insurance. The major outcome included receipt of MRI biopsy versus standard biopsy and for these sub-populations, subsequent 2-month post-biopsy metastatic versus non-metastatic prostate cancer diagnosis and within 1-year prostate cancer treatment (prostatectomy with or without radiation versus prostatectomy-only) were compared using dichotomous (primary) and time-to-event (secondary) endpoints. Of 17,493 patients with a first-time prostate biopsy, 3.89% had MRI guided biopsies; of the 17,128 patients with no pre-biopsy cancer diagnosis, the subsequent prostate cancer diagnosis rate was 42.59%. For 6,754 non-metastatic prostate cancer patients with 1-year follow-up, 1,674 (24.79%) received surgery (with or without radiation) and 495 (7.33%) received radiation-only. Holding other factors constant, multivariable regression models identified that race-insurance was a primary predictor of MRI-guided biopsy use. Compared to commercially insured White patients, Black patients across all insurance categories received MRI-guided biopsies less frequently; Commercially insured and self-pay Black patients also had increased chance of prostate cancer diagnosis. Across all insurers, Black patients had lower likelihood of prostatectomies. In contrast, Black and White patients with government insurance were more likely to have within 1-year radiation-only treatments versus commercially insured White patients. Thus, across the prostate cancer care continuum, race-insurance affected prostate cancer-related service utilization. Future research should evaluate the generalizability of these New York State findings.

Chandra MM ，Greenspan SH ，Li X ，Yang J ，Pryor AD ，Shroyer ALW ，Fitzgerald JP ... -  《-》

Contemporary Trends in Magnetic Resonance Imaging at the Time of Prostate Biopsy: Results from a Large Private Insurance Database.

Magnetic resonance imaging (MRI) of the prostate (MRI-prostate) facilitates better detection of clinically significant prostate cancer (PCa). Yet, the national trends of MRI at the time of prostate biopsy and its ability to increase the detection of PCa in a biopsy-naïve population remain unknown. To elucidate the contemporary trends of MRI and prostate biopsy, and whether it improved PCa diagnosis among privately insured patients. This was a retrospective cohort study of a large private health insurance database in the USA-the OptumLabs Data Warehouse. We identified all men ≥40 yr of age who underwent index prostate biopsies from 2010 through 2016. MRI-prostate at the time of index biopsy. Utilization of the MRI at the time of biopsy and incident PCa diagnosis constituted the primary outcomes. We enumerated unadjusted and age-specific annual rates of MRI over time to elucidate trends using regression models (trend analysis). Bivariate and multivariable regression analyses identified patient characteristics associated with MRI-prostate, and the association between the use of MRI and PCa diagnosis. Overall, 119 202 men underwent index prostate biopsies. Unadjusted annual rates of MRI at the time of biopsy significantly increased from 7 per 1000 biopsies in 2010 to 83 per 1000 biopsies in 2016 (p < 0.001 for trend). Age-specific rates increased across all age groups (40-49, 50-59, 60-65, 66-74, and 75+ yr; all p < 0.001). On multivariable analysis, black patients had a lower likelihood of MRI compared with white patients (odds ratio [OR]: 0.6; p < 0.01). MRI at the time of biopsy was not associated with a higher likelihood of incident PCa compared with traditional systematic biopsy (OR: 1.0; p = 0.7). The retrospective design and the inability to detect clinically significant PCa (Gleason 7+) constitute the limitations of this study. While the use of MRI at the time of biopsy rose markedly, it was not associated with a higher detection rate of PCa. Further research is needed to address effective dissemination of MRI and targeted biopsies, and racial disparities. From 2010 to 2016, our study found a significant rise in the utilization of magnetic resonance imaging of the prostate (MRI-prostate) at the time of index biopsy, although only a minority of patients undergo MRI-prostate. The use of MRI-prostate was not associated with a higher likelihood of diagnosing incident prostate cancer.

Kim SP ，Karnes RJ ，Mwangi R ，Van Houten H ，Gross CP ，Gershman B ，Leapman MS ，Shah ND ... -  《-》

Impact of prebiopsy magnetic resonance imaging of the prostate on cancer detection and treatment patterns.

Though superior in clinical trial settings, outcomes following magnetic resonance image (MRI)-guided prostate biopsies have not been reported broadly. We compared prostate cancer detection rates for men who did and did not undergo prebiopsy MRI and evaluated treatment patterns based on biopsy approach, year of biopsy, and proximity to early adopters. Using private insurance claims (2009-2015), we identified men who underwent prostate biopsy using appropriate procedure codes. Exposure was receipt of prebiopsy MRI within 3 months prior to biopsy. Outcomes included new prostate cancer diagnosis, treatment with prostatectomy/radiation, and receipt of adjunct procedures typically used for higher-risk disease (i.e., lymphadenectomy with prostatectomy, androgen deprivation therapy with radiation). Hierarchical mixed-effects multivariable logistic regression predicted probabilities of each outcome. We identified 77,350 men (mean age 57.5 ± 5.4 years) who underwent biopsy with 12% having had a prior negative biopsy. Use of prebiopsy MRI was more common among men biopsied from 2014 to 2015 (4.4% vs. 1.3% 2012-2013), in metropolitan statistical areas (2.6% vs. 1.1% not), residing close to early adopters (5.5% vs. 1.5% far), and with prior negative biopsy (7.3% vs. 1.7% biopsy-naïve; all P < 0.001). Compared to patients with a prior negative biopsy and no MRI, men were more likely to be diagnosed with prostate cancer if they had a prior negative biopsy and MRI (24.7% vs. 21.4% prior negative without MRI, odds ratio 1.25, 95% confidence interval 1.04-1.51) or an initial biopsy without prior MRI (40.0% vs. 21.4% prior negative without MRI, odds ratio 2.49, 95% confidence interval 2.36-2.64; P < 0.001). Predicted probability of treatment overall and adjunct treatment did not differ based on receipt of pre-biopsy MRI. Among privately insured men in the United States, use of prostate MRI prior to prostate biopsy was associated with increased cancer detection among those with prior negative biopsies, but we did not observe significant changes with downstream treatment patterns.

Liu W ，Patil D ，Howard DH ，Moore RH ，Wang H ，Sanda MG ，Filson CP ... -  《-》

Racial and Ethnic Disparities in the Use of Prostate Magnetic Resonance Imaging Following an Elevated Prostate-Specific Antigen Test.

Abashidze N ，Stecher C ，Rosenkrantz AB ，Duszak R Jr ，Hughes DR ... -  《-》

Black Race, Hispanic Ethnicity, and Medicaid Insurance Are Associated With Lower Rates of Rotator Cuff Repair in New York State.

To determine the use of operative rotator cuff repair for rotator cuff pathology in New York State and analyze the racial, ethnic, and income-based disparities in receiving rotator cuff repair. A retrospective review of the Statewide Planning and Research Cooperative System Database of New York State was conducted to include patients with a new diagnosis of rotator cuff tear between July 1, 2017, and June 30, 2019, with at least 6 months of follow-up. Bivariate analysis using χ2 tests and multivariable logistic regression models were used to determine racial, ethnic, and income-based disparities in the use of surgical treatment with rotator cuff repair. A total of 87,660 patients were included in the study. Of these, 36,422 patients (41.5%) underwent surgical treatment with rotator cuff repair. Multivariable analysis showed that Black race (adjusted odds ratio [aOR] 0.78; 95% confidence interval [CI] 0.69-0.87; P < .001), Hispanic/Latino ethnicity (aOR 0.91; 95% CI 0.85-0.97); P = .004), and Medicaid (aOR 0.75; 95% CI 0.70-0.80; P < .001), or other government insurance (aOR 0.82; 95% CI 0.78-0.86; P < .001) were independently associated with lower rates of rotator cuff repair. Male sex (aOR 1.18; 95% CI 1.14-1.22; P < .001), Asian race (aOR 1.27; 95% CI 1.00-1.62; P = .048), workers' compensation insurance (aOR 1.12; 95% CI 1.07-1.18; P < .001), and greater home ZIP code income quartile (aOR 1.19; 95% CI 1.09-1.30; P < .001) were independently associated with greater rates of operative management. Although race was an independent covariate affecting rate of rotator cuff repair, the effects of race were altered when accounting for the other covariates, suggesting that race alone does not account for the differences in rate of surgery for rotator cuff pathology. In this analysis of all adult patients presenting with rotator cuff tears to New York hospital systems from 2017 to 2019, we identified significant racial, ethnic, and socioeconomic disparities in the likelihood of rotator cuff repair surgery for patients with rotator cuff tears. These include lower rates of rotator cuff repair for those Black, Hispanic, and low-income populations as represented by Medicaid insurance and low home ZIP code income quartile. This study reports disparities in the use of rotator cuff repair for individuals with rotator cuff pathology.

Hwang A ，Zhang L ，Ramirez G ，Maloney M ，Voloshin I ，Thirukumaran C ... -  《-》