Impact of sexual orientation on contemporary rates of prostate cancer screening.

Abstract

122 Background: Despite increasing societal acceptance of non-heterosexual persons, sexual minorities continue to face discrimination. The effect of non-heterosexual orientation on adoption of cancer preventive services, particularly prostate cancer screening (PSAS), is not clearly known. We hypothesize that male sexual minorities are less likely to receive PSAS compared to heterosexual (HTS) males. Methods: The 2014-16 Behavioral Risk Factor Surveillance System was queried for males 40-69, without a history of prostate cancer, and having answered all sexual orientation (SO) questions. PSAS occurred if a respondent had a PSA test within the last two years for reasons other than “a prostate problem” or “for prostate cancer”. Descriptive statistics were generated for demographic covariates stratified by year and SO [HTS, homosexual (HMS), bisexual (BIS), transgender (TGR), other, and refused]. The Chi-Square test was used to compare the distribution of covariate proportions amongst SO categories within each year. Multivariable regression was used to determine the independent effect of SO and other covariates on receipt of PSAS in this cohort. Results: A weighted 49.2 million individuals (n = 86,893) met inclusion criteria. In 2014 and 2016, 94% and 93% of the cohort identified as HTS. In both years, a higher proportion of HMS (2014: 40.5%, 2016: 47.4) and BIS (2014: 30.3%, 2016: 31.0%) respondents were college graduates compared to HTS males (2014: 28.8%, 2016: 28.9%). In 2014, rates of PSAS were higher amongst HMS (34.9%), BIS (37.1%) and TGR (37.5%) individuals compared to HTS individuals (34.5%). In 2016, rates of PSAS were clinically similar among HTS (30.4%), HMS (30.2%), BIS (30.1%), and TGR (27.8%) individuals. In the multivariable analysis, increasing age (65-69 OR 8.93, 95%CI 7.80-10.22) and education level (College Graduate OR 2.21, 95%CI 1.93-2.54) along with insurance coverage (OR 2.15, 95%CI 1.85-2.51) and a personal physician (OR 2.88, 95%CI 2.59-3.20) were associated with higher odds of PSAS. Aside from HMS orientation (OR 1.30, 95%CI 1.04-1.62), SO was not an independent predictor of PSAS. Conclusions: Based on this nationally representative sample, disparities in regards to PSAS are not apparent for non-HTS males.