College of Medicine, University of Arizona, Phoenix, Arizona.
College of Health Solutions, Arizona State University, Phoenix, Arizona.
Urol Pract. 2023 Nov;10(6):612-619. doi: 10.1097/UPJ.0000000000000435. Epub 2023 Sep 26.
We assessed racial and ethnic disparities in the use of prostate biopsy or MRI following an elevated PSA result.
We retrospectively evaluated insurance claims from Optum's de-identified Clinformatics Data Mart database from January 1, 2011 to December 31, 2017. This was a large commercially insured cohort from across the United States. We included all male enrollees over 40 years old receiving an elevated PSA result with no prior prostate biopsy or MRI and no confirmed urinary tract infection within 6 weeks of PSA test.
A total of 765,409 participants met inclusion criteria with 43,711 (5.71%) receiving a PSA result above 4 ng/mL. Of these, 7,399 received either a prostate biopsy or MRI within 180 days. Men between ages 40-54 (29.48%) were most likely to receive prostate biopsy or MRI after an elevated PSA, followed by those between 55-64 (24.91%), 65-74 (18.56%), 75-84 (6.33%), and above 85 (3.62%). Compared to White patients, Black patients were more likely to receive either a prostate biopsy or MRI (OR: 1.16, 95% CI: 1.01, 1.32) following an elevated PSA level, while Asian (OR: 0.72, 95% CI: 0.54, 0.96) and Hispanic (OR: 0.83, 95% CI: 0.70, 0/97) patients were less likely.
Physicians appear to be following the reported statistical incidence of prostate cancer by race and ethnicity when using prostate biopsy or MRI for patients with elevated PSA levels. These results demonstrate the importance of publishing statistical data on disease incidence by race and ethnicity for informing physicians' decision-making.
我们评估了在 PSA 升高后，前列腺活检或 MRI 的使用在种族和民族方面的差异。
我们回顾性地评估了来自 Optum 去识别 Clinformatics Data Mart 数据库的保险索赔，时间范围为 2011 年 1 月 1 日至 2017 年 12 月 31 日。这是一个来自美国各地的大型商业保险队列。我们纳入了所有 40 岁以上的男性参保者，他们的 PSA 结果升高，且在 PSA 检测后 6 周内没有接受过前列腺活检或 MRI，也没有确诊尿路感染。
共有 765409 名参与者符合纳入标准，其中 43711 名（5.71%）PSA 结果高于 4ng/ml。在这些人中，7399 人在 180 天内接受了前列腺活检或 MRI。年龄在 40-54 岁之间的男性（29.48%）最有可能在 PSA 升高后接受前列腺活检或 MRI，其次是年龄在 55-64 岁之间的男性（24.91%）、65-74 岁之间的男性（18.56%）、75-84 岁之间的男性（6.33%）和 85 岁以上的男性（3.62%）。与白人患者相比，黑人患者在 PSA 升高后更有可能接受前列腺活检或 MRI（OR：1.16，95%CI：1.01，1.32），而亚洲人（OR：0.72，95%CI：0.54，0.96）和西班牙裔（OR：0.83，95%CI：0.70，0.97）患者则不太可能。
医生在 PSA 升高的患者中使用前列腺活检或 MRI 时，似乎遵循了按种族和民族报告的前列腺癌发病率统计数据。这些结果表明，按种族和民族公布疾病发病率的统计数据对于医生的决策非常重要。
