Geographic variability in contemporary utilization of PET imaging for prostate cancer: a medicare claims cohort study
Abstract Background Potential rural-urban differences in prostate cancer care are understudied, particularly regarding the utilization of advanced diagnostic tests. Herein we examined variations in Positron Emission Tomography (PET) utilization for prostate cancer care, including diagnosis, staging...
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BMC
2025-07-01
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| Series: | Cancer Imaging |
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| Online Access: | https://doi.org/10.1186/s40644-025-00898-6 |
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| author | Stephan M. Korn Zhiyu Qian Hanna Zurl Nathaniel Hansen Klara K. Pohl Daniel Stelzl Filippo Dagnino Stuart Lipsitz Jianyi Zhang Adam S. Kibel Caroline M. Moore Kerry L. Kilbridge Shahrokh F. Shariat Stacy Loeb Hebert Alberto Vargas Quoc-Dien Trinh Alexander P. Cole |
| author_facet | Stephan M. Korn Zhiyu Qian Hanna Zurl Nathaniel Hansen Klara K. Pohl Daniel Stelzl Filippo Dagnino Stuart Lipsitz Jianyi Zhang Adam S. Kibel Caroline M. Moore Kerry L. Kilbridge Shahrokh F. Shariat Stacy Loeb Hebert Alberto Vargas Quoc-Dien Trinh Alexander P. Cole |
| author_sort | Stephan M. Korn |
| collection | DOAJ |
| description | Abstract Background Potential rural-urban differences in prostate cancer care are understudied, particularly regarding the utilization of advanced diagnostic tests. Herein we examined variations in Positron Emission Tomography (PET) utilization for prostate cancer care, including diagnosis, staging and treatment planning, across residential regions in the United States. Methods Patients newly diagnosed with prostate cancer between 2019 and 2021 and post-diagnostic PETs were identified using full Medicare claims data. PET use was assessed in all newly diagnosed patients, though indications vary by risk. Patients’ counties were categorized as metro, urban, or rural, from most to least urbanized. Regional PET utilization was further examined at the level of hospital referral regions. A multivariable logistic regression model was performed to assess the impact of rurality on PET imaging. A secondary analysis included an interaction term for race to explore the effect of residence on PET imaging by racial group. Results Overall, 495 865 patients were included in the analysis: 393 861 (79.4%) lived in metro, 56 698 (11.4%) in urban and 39 707 (8.0%) in rural counties. Patients in metro counties underwent PET imaging more often (8.4%) than patients in urban (7.3%) or rural counties (7.2%), p < 0.0001. At a level of hospital referral region, PET utilization rates ranged from 2.2 to 20.8%. PET imaging was more commonly performed in White compared to Black or Hispanic patients. Rural patients were less likely to undergo PET imaging compared to metro patients (odds ratio [OR] 0.87, 95% Confidence interval [CI]: 0.82–0.92 p < 0.0001). Rural Black (OR 0.69, 95%CI 0.57–0.83, p < 0.0001) and rural White patients (OR 0.89, 95%CI 0.83–0.94 p < 0.0001) were less likely to obtain PET imaging compared to their metro counterparts, p-interaction < 0.0001. Conclusion Rural patients were less likely to undergo PET imaging than metro patients. The effect of rurality was most pronounced among Black patients. Our findings underscore the need for strategies to support equitable use of PET imaging. |
| format | Article |
| id | doaj-art-f74a48fdfa784e2882ea35930fa2fae2 |
| institution | Kabale University |
| issn | 1470-7330 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | Cancer Imaging |
| spelling | doaj-art-f74a48fdfa784e2882ea35930fa2fae22025-08-20T04:01:35ZengBMCCancer Imaging1470-73302025-07-0125111210.1186/s40644-025-00898-6Geographic variability in contemporary utilization of PET imaging for prostate cancer: a medicare claims cohort studyStephan M. Korn0Zhiyu Qian1Hanna Zurl2Nathaniel Hansen3Klara K. Pohl4Daniel Stelzl5Filippo Dagnino6Stuart Lipsitz7Jianyi Zhang8Adam S. Kibel9Caroline M. Moore10Kerry L. Kilbridge11Shahrokh F. Shariat12Stacy Loeb13Hebert Alberto Vargas14Quoc-Dien Trinh15Alexander P. Cole16Department of Urology, Medical University of ViennaCenter for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical SchoolCenter for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical SchoolDepartment of Urology, Mass General Brigham, Harvard Medical SchoolCenter for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical SchoolCenter for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical SchoolCenter for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical SchoolCenter for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical SchoolCenter for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical SchoolDepartment of Urology, Mass General Brigham, Harvard Medical SchoolUniversity College LondonLank Center for Genitourinary Oncology, Dana-Farber Cancer InstituteKarl Landsteiner Institute of Urology and AndrologyDepartment of Urology and Population Health, New York University Langone Health and Manhattan Veterans AffairsDepartment of Radiology, New York University Langone HealthDepartment of Urology, University of PittsburghCenter for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical SchoolAbstract Background Potential rural-urban differences in prostate cancer care are understudied, particularly regarding the utilization of advanced diagnostic tests. Herein we examined variations in Positron Emission Tomography (PET) utilization for prostate cancer care, including diagnosis, staging and treatment planning, across residential regions in the United States. Methods Patients newly diagnosed with prostate cancer between 2019 and 2021 and post-diagnostic PETs were identified using full Medicare claims data. PET use was assessed in all newly diagnosed patients, though indications vary by risk. Patients’ counties were categorized as metro, urban, or rural, from most to least urbanized. Regional PET utilization was further examined at the level of hospital referral regions. A multivariable logistic regression model was performed to assess the impact of rurality on PET imaging. A secondary analysis included an interaction term for race to explore the effect of residence on PET imaging by racial group. Results Overall, 495 865 patients were included in the analysis: 393 861 (79.4%) lived in metro, 56 698 (11.4%) in urban and 39 707 (8.0%) in rural counties. Patients in metro counties underwent PET imaging more often (8.4%) than patients in urban (7.3%) or rural counties (7.2%), p < 0.0001. At a level of hospital referral region, PET utilization rates ranged from 2.2 to 20.8%. PET imaging was more commonly performed in White compared to Black or Hispanic patients. Rural patients were less likely to undergo PET imaging compared to metro patients (odds ratio [OR] 0.87, 95% Confidence interval [CI]: 0.82–0.92 p < 0.0001). Rural Black (OR 0.69, 95%CI 0.57–0.83, p < 0.0001) and rural White patients (OR 0.89, 95%CI 0.83–0.94 p < 0.0001) were less likely to obtain PET imaging compared to their metro counterparts, p-interaction < 0.0001. Conclusion Rural patients were less likely to undergo PET imaging than metro patients. The effect of rurality was most pronounced among Black patients. Our findings underscore the need for strategies to support equitable use of PET imaging.https://doi.org/10.1186/s40644-025-00898-6Prostate cancerRural populationUrban populationPositron-emission tomographyHealthcare disparities |
| spellingShingle | Stephan M. Korn Zhiyu Qian Hanna Zurl Nathaniel Hansen Klara K. Pohl Daniel Stelzl Filippo Dagnino Stuart Lipsitz Jianyi Zhang Adam S. Kibel Caroline M. Moore Kerry L. Kilbridge Shahrokh F. Shariat Stacy Loeb Hebert Alberto Vargas Quoc-Dien Trinh Alexander P. Cole Geographic variability in contemporary utilization of PET imaging for prostate cancer: a medicare claims cohort study Cancer Imaging Prostate cancer Rural population Urban population Positron-emission tomography Healthcare disparities |
| title | Geographic variability in contemporary utilization of PET imaging for prostate cancer: a medicare claims cohort study |
| title_full | Geographic variability in contemporary utilization of PET imaging for prostate cancer: a medicare claims cohort study |
| title_fullStr | Geographic variability in contemporary utilization of PET imaging for prostate cancer: a medicare claims cohort study |
| title_full_unstemmed | Geographic variability in contemporary utilization of PET imaging for prostate cancer: a medicare claims cohort study |
| title_short | Geographic variability in contemporary utilization of PET imaging for prostate cancer: a medicare claims cohort study |
| title_sort | geographic variability in contemporary utilization of pet imaging for prostate cancer a medicare claims cohort study |
| topic | Prostate cancer Rural population Urban population Positron-emission tomography Healthcare disparities |
| url | https://doi.org/10.1186/s40644-025-00898-6 |
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