Abstract
Objectives. Although research demonstrates the public health burden of prostate cancer among men in the Caribbean, relatively little is known about the factors that underlie the low levels of testing for the disease among this population. Study Design. A cross-sectional study of prostate cancer testing behaviours among men aged 40–60 years in Dominican Republic using the Demographic and Health Survey (2013). Methods. We use hierarchical binary logit regression models and average treatment effects combined with propensity score matching to explore the determinants of prostate screening as well as the average effect of health insurance coverage on screening. The use of hierarchical binary logit regression enabled us to control for the effect of unobserved heterogeneity at the cluster level that may affect prostate cancer testing behaviours. Results. Screening varied significantly with health insurance coverage, knowledge of cholesterol level, education, and wealth. Insured men were more likely to test for prostate cancer (OR = 1.65, p = 0.01) compared to the uninsured. Conclusions. The expansion and restructuring of Dominican Republic universal health insurance scheme to ensure equity in access may improve health access that would potentially impact positively on prostate cancer screening among men.
Highlights
Dominican Republic (DR) is suffering from the double burden of disease as infectious diseases remain whilst noncommunicable diseases have witnessed an increased share of the burden of diseases [1,2,3]
Among the sociocultural factors, compared to urban men, men dwelling in rural areas were less likely (OR = 0.76, p = 0.01) to test for prostate cancer while residents in region IV (OR = 0.64, p = 0.01) were less likely to test for prostate cancer compared to region I
Increasing levels of wealth were associated with men testing for prostate cancer; poor (OR = 1.39, p = 0.01), middle (OR = 2.19, p = 0.01), richer (OR = 3.49, p = 0.01), and richest wealth quintiles (OR = 6.41, p = 0.01) were more likely to test for prostate cancer compared to the poorer category
Summary
Dominican Republic (DR) is suffering from the double burden of disease as infectious diseases remain whilst noncommunicable diseases have witnessed an increased share of the burden of diseases [1,2,3]. Mortality due to noncommunicable causes already accounts for a considerably higher proportion of deaths than communicable causes, rising to 73% of diagnosed deaths in 2005 [1, 4]. Of these noncommunicable diseases, prostate cancer is the leading cause of cancer related deaths in the DR and the Caribbean at large [5, 6]. An important factor in these global disparities in incidence rates and trends is due to the lack of diagnostic facilities and prostate-specific antigen (PSA) testing in most low-resource settings [10]
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