Predictors of Disparities in Recommendation and Rates of Prostate Cancer Screening

Abstract

Studies have investigated implications of changes in screening guidelines including disparities in prostate cancer screening across various demographics factors. However, there are only few studies investigating patterns of prostate cancer screening in men before and after implementation of the 2018 USPSTF guideline. Therefore, in the current study, we assessed provider’s recommendations of prostate cancer screening as well as the demographic predictors of screening rates among men without a history of prostate cancer as it relates to the USPSTF guidelines. Many health indicators are collected in non-institutionalized civilian adults by the Center for Disease Control Behavioral Risk Factor Surveillance System (BRFSS), a population-based, cross-sectional survey of US adults. This study, spanning six years from 2013-2018, includes men without history of cancer who had complete data regarding status of PSA test in the past 2 years. Participants also reported being informed about PSA test by their providers and if PSA test was recommended to them. Multivariable logistic regression defined adjusted odds ratios (AOR) and 95% confidence intervals (CI) in a model with recommendation of PSA testing and PSA test within the past 2 years separately as the dependent variable of interest and patients’ race and age as the independent variables. Among 146,038 male participants without a history of cancer, adults ages 70 years and older were more likely to receive PSA screening recommendations relative to adults aged 55-70 (62.5% vs 49.22%, AOR 1.44, 95% CI 1.33-1.55, P<0.001). Adults ages ≥70 years also had higher screening relative to adults ages 55-69 years whether screening was recommended (AOR 1.29, 95% CI 1.19-1.39) or not recommended (AOR 1.54, 95% CI 1.35-1.75) by their providers. Finally, providers were more likely to recommend PSA screening to African Americans (55.55% vs 54.13%, AOR 1.30, 95% CI 1.20-1.42, P<0.001) and less likely to Native Americans (37.95 vs 54.13%, AOR 0.65, 95% CI 0.51-0.82, P<0.001) and Asians (32.42% vs 54.13%, AOR 0.37, 95% CI 0.31-0.45) relative to Whites. Participants ≥70 years old were more likely to get PSA screening recommendations relative to those aged 55-69 years despite the grade D recommendation by USPSTF screening guidelines. In addition, while African American participants were more likely to get PSA screening recommendations and higher PSA screening rates, Native Americans and Asian participants had lower screening and recommendation rates relative to their White counterparts. Our results show that more work needs to be done at the primary care level to reduce rates of PSA screening in the aging population. Our work also shows the need for increased awareness of PSA screening particularly in adults 55-69 years old of Native American or Asian origin.