Chandra Mansi M, Greenspan Seth H, Li Xiaoning, Yang Jie, Pryor Aurora D, Shroyer Annie Laurie Winkley, Fitzgerald John P
Renaissance School of Medicine at Stony Brook University Stony Brook, NY 11794-8093, USA.
Department of Surgery, Health, Stony Brook Medicine Stony Brook, NY 11794-8191, USA.
Am J Clin Exp Urol. 2021 Dec 15;9(6):435-455. eCollection 2021.
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.
对于器官局限性前列腺癌，影响磁共振成像（MRI）引导下活检的使用以及下游前列腺癌患者治疗的社会经济因素尚不清楚。这项回顾性观察队列研究使用纽约州全州规划与研究合作系统（SPARCS）基于计费代码的数据库，来检验前列腺患者的社会经济特征对前列腺癌治疗的影响，前列腺癌治疗定义为初次活检、活检后2个月癌症诊断以及1年内癌症相关干预，并控制其他风险因素。2011年至2017年期间，研究人群（n = 18,253）包括所有居住在纽约州、年龄在18至75岁之间、未曾接受过前列腺切除术且首次接受活检的男性居民；由于数据质量问题，2016年的760份此类患者记录被剔除。主要暴露因素包括患者年龄、种族、族裔和保险情况。主要结局包括接受MRI活检与标准活检的情况，对于这些亚组人群，使用二分法（主要）和事件发生时间（次要）终点比较活检后2个月时转移性与非转移性前列腺癌诊断情况以及1年内前列腺癌治疗情况（有或无放疗的前列腺切除术与仅前列腺切除术）。在17,493例首次接受前列腺活检的患者中，3.89%接受了MRI引导下活检；在17,128例活检前未诊断出癌症的患者中，随后的前列腺癌诊断率为42.59%。对于6,754例接受1年随访的非转移性前列腺癌患者，1,674例（24.79%）接受了手术（有或无放疗），495例（7.33%）仅接受了放疗。在其他因素保持不变的情况下，多变量回归模型确定种族 - 保险情况是MRI引导下活检使用的主要预测因素。与商业保险的白人患者相比，所有保险类别的黑人患者接受MRI引导下活检的频率较低；商业保险和自费的黑人患者前列腺癌诊断的几率也更高。在所有保险公司中，黑人患者接受前列腺切除术的可能性较低。相比之下，与商业保险的白人患者相比，有政府保险的黑人和白人患者在1年内仅接受放疗治疗的可能性更高。因此，在前列腺癌治疗的整个过程中，种族 - 保险情况影响了前列腺癌相关服务的利用。未来的研究应评估这些纽约州研究结果的可推广性。
