Area-Level Social Deprivation and Use of Prostate MRI Before Prostate Biopsy Among Commercial Insurance Beneficiaries.

OBJECTIVE: To better characterize patterns of prostate magnetic resonance imaging (MRI) use in the United States, we assessed the association between area-level sociodemographic factors and receipt of prostate MRI prior to biopsy. METHODS: We conducted a retrospective, dynamic cohort study of Blue Cross Blue Shield beneficiaries to assess the use of MRI before prostate biopsy. The primary objective was to evaluate the association between pre-biopsied MRI and social deprivation index (SDI), a composite measure of area-level deprivation. In addition, we calculated bimonthly rates of pre-biopsy MRI use and compared differences by SDI tertiles, as well as rural/urban status, as well as by state. RESULTS: Among 112,567 beneficiaries undergoing prostate biopsy from 2016 to 2022, the proportion receiving pre-biopsy MRI increased from 9.5% in early 2016 to 33.2% by mid-2022 (P-trend <.01). MRI use varied significantly by geography and area-level measures of socioeconomic status. Among patients diagnosed in 2022, pre-biopsy MRI use was higher among beneficiaries residing in the least deprived (38.0% in lowest SDI tertile) as compared with the most deprived (27.0% in highest tertile) areas. Beneficiaries in metropolitan areas more commonly received pre-biopsy MRI (35.4% in 2022) compared to non-metropolitan areas (22.5%). Utilization was highest among patients aged 70-99 (35.3% in 2022) and lowest among those under 50 (31.3% in 2022). CONCLUSION: While the use of MRI prior to prostate biopsy has increased among commercially insured beneficiaries, MRI use remains low overall and varies across regions and strata of socioeconomic status.

Duke Scholars

Author Michaela Ann Dinan Population Health Sciences