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Determinants of PSA screening among Black men in the United States in the contemporary era.
Jesse Sammon, DO1, Deepansh Dalela, MD2, Firas Abdollah, MD2, Paul Han, MD3, Moritz Hansen, MD1, Mani Menon, MD4, Quoc-Dien Trinh, MD5.
1Maine Medical Center, Portland, ME, USA, 2Henry Ford Hospital, Detroit, MI, USA, 3Maine Medical Center Research Institute, Portland, ME, USA, 4Henry Ford Hospitaly, Detroit, MI, USA, 5Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA.

BACKGROUND:Black men have a substantially higher PCa incidence than White men (~220 vs. 133 cases per 100,000 men) and a mortality rate that is more than twice their White counterparts. Early identification of PCa in Black males may therefore be of benefit in forestalling consequent morbidity and mortality. While guidelines issued by major professional bodies do identify Black men as high-risk population for PCa, significant uncertainty exists for patients and their HCPs alike. This uncertainty may be further compounded by the USPSTF recommendation against PSA screening in all men irrespective of age. The substantive questions surrounding PSA screening in Black vs. White males are reflected in previous reports showing contradictory findings. A contemporary analysis thus becomes imperative to provide a heuristic framework for identifying the baseline prevalence and predictors of PSA screening amongst Black men, not least because of its potential implications in healthcare policy.
METHODS: We compared the rate of self-reported PSA screening in Black men relative to non-Hispanic Whites (NHW). The Behavioral Risk Factor Surveillance System (BRFSS) 2012 dataset was used to identify asymptomatic men (aged 40-99) who reported undergoing PSA screening in the past 12 months. Age, education, income, residence location, marital status, health insurance, regular access to health care provider (HCP) and HCP’s recommendation to undergo screening were extracted. Subgroup analyses by race and age were performed using complex samples logistic regression models to assess the odds of undergoing PSA screening.
RESULTS: In 2012, there were 122,309 survey respondents (weighted estimate 54.5milllion) in the studied population; of these, 29% of Black and 32% of NHW men reported undergoing PSA screening. Younger black males had higher rates and odds of screening than similar-aged NHWs (1.66, 1.58 and 1.36 for men aged 45-49, 50-54 and 55-59 respectively). Among Black men, only higher education level (odds ratio [OR]=2.12 for men who were graduates vs. not), regular access to HCP (OR=2.05) and HCP’s recommendation for screening (OR=8.43) were independently associated with PSA screening. The association between race receipt of PSA screening was moderated by HCP recommendation, age, educational and insurance status (p for all interaction terms<0.05), but not by regular access to HCP (p=0.2).
CONCLUSIONS:Against the backdrop of higher morbidity and mortality of PCa in Black men, and the possible benefit afforded by early PSA screening in alleviating these disparities, our study provides evidence of the increased prevalence and odds of PSA screening in young (aged 45-60) Black males. While all parameters of higher socioeconomic status are predictive of screening behavior in Whites, only higher education, regular access to healthcare provider and physician recommendation were significantly associated with the likelihood of undergoing PSA screening in Black men. Future research to explore the complex gestalt of systemic factors (specifically, the association between race, socio-economic achievements and educational status in predicting screening behavior) may aid in optimizing PSA screening in this high-risk subpopulation.


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