In a study published by Abashidze et al in JAMA Network Open, the investigators found that Black men were at least 23.6% less likely than White men to undergo magnetic resonance imaging (MRI) following an elevated prostate-specific antigen (PSA) test result. They also found that Hispanic and Asian men with elevated PSA results were significantly less likely to be referred for MRI evaluation.
The findings are particularly troubling in light of the elevated risk of prostate cancer that Black men face; previous studies have found Black men are more likely to develop prostate cancer, often get the disease earlier in life, and are more likely to die from it.
Study Methods
The study was conducted as part of a long-term research collaboration between the Health Economics and Analytics Lab (HEAL) at the School of Economics of Georgia Institute of Technology and the Emory University School of Medicine. HEAL uses big-data analytics to reveal emerging patterns in health-care utilization with the aim of benefiting patients and providers.
For the study, the authors examined anonymous health insurance claims data covering 50 U.S. states looking for men who took PSA blood tests. They identified 794,809 PSA tests that had laboratory results available. They then looked for matching records indicating whether or not the men received a follow-up MRI based on varying levels of PSA identified in each man’s blood.
Although medical standards for the use of prostate MRIs continue to emerge, studies have revealed thresholds that warrant further investigation, and those are the levels the HEAL study examined. They are 4 ng/mL, historically considered the threshold for recommending prostate biopsy; 2.5 ng/mL, a more recently recognized threshold for the early detection of prostate cancer; and 10 ng/mL, a level that has been associated with higher rates of biopsies and cancer diagnoses.
We need to understand more about the role of decision-making biases in physicians, as well as other potential factors in the health-care system that could account for the disparities we are seeing in this study.— Danny R. Hughes, PhD
Tweet this quote
Results
Black patients between the ages of 40 and 54 with a PSA above 4 ng/mL were 39.8% less likely to receive a follow-up prostate MRI than White patients. Black men between the ages of 65 and 74 whose PSA results were above 4 ng/mL were 23.6% less likely to get a follow-up MRI. Those with levels above 10 ng/mL were 43.9% less likely to receive one.
Black men between the ages of 65 and 74 with results above the 4 ng/mL threshold were 23.6% less likely to get an MRI when compared to White patients; men in this age group with scores above 10 ng/mL were 43.9% less likely to receive an MRI.
Asian patients between the ages of 55 and 64 with results above 2.5 ng/mL were 57.3% less likely to receive a prostate MRI as compared to White patients; Asian men with scores above 4 ng/mL were 62.9% less likely to receive one.
Hispanic men between the ages of 55 to 64 with PSA results above 10 ng/mL were 67.6% less likely to receive an MRI than White patients.
Cause of the Disparities
Study author Danny R. Hughes, PhD, of the School of Economics at the Georgia Institute of Technology, and his colleagues are now turning their attention to understanding the cause of the disparities. The data used in the study do not reveal the reasons men did or did not receive referrals for MRIs.
It could be that patients who did not get the MRIs opted out of the tests, including some who may have instead been referred to receive an invasive biopsy test, despite the problems that can be associated with those tests. Or, Dr. Hughes said, the results may be further confirmation of previous studies that have shown significant biases among physicians in how they care for Black, Hispanic, and Asian patients compared to White patients. Previous studies have shown, for instance, that doctors are less likely to discuss treatment options and side effects with Black patients when compared to their White counterparts.
“We need to understand more about the role of decision-making biases in physicians, as well as other potential factors in the health-care system that could account for the disparities we are seeing in this study,” concluded Dr. Hughes.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
