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Racial differences in screening for prostate cancer in the elderly
Timothy Gilligan1, Philip S Wang, Raisa Levin
1Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA. Timothy_Gilligan@dfci.harvard.edu
Archives of Internal Medicine
|September 29, 2004
Summary
Black men are significantly less likely to undergo prostate-specific antigen (PSA) screening compared to white men, contributing to advanced diagnoses and higher mortality rates. This disparity persists even after accounting for socioeconomic factors.
Area of Science:
- Urology
- Public Health
- Health Disparities
Background:
- Black men face higher rates of advanced prostate cancer and mortality compared to white men.
- Low screening rates in Black men may exacerbate these disparities, yet data on racial differences in screening are limited.
Purpose of the Study:
- To investigate racial disparities in prostate-specific antigen (PSA) screening among Medicare beneficiaries in New Jersey.
- To assess the association between race and prostate cancer screening utilization.
Main Methods:
- A case-control study utilizing statewide claims data from Medicare, Medicaid, and pharmaceutical assistance programs.
- Exclusion of prevalent prostate cancer cases using the state's cancer registry.
- Analysis of 33,463 case patients and 33,782 control subjects, matched by birth month and year.
Main Results:
- Black race was strongly and inversely associated with PSA screening (OR=0.50).
- Poverty and near poverty also showed inverse associations with screening.
- Multivariate analysis confirmed Black race as a significant predictor of not undergoing PSA screening (OR=0.65).
Conclusions:
- Elderly Black men are substantially less likely to undergo PSA screening than elderly white men.
- Socioeconomic status and comorbidities explain only a minor portion of the observed racial differences in screening rates.