Spatio-temporal variation in prostate cancer testing in Stockholm: A population-based study

Area of Science:

• Urology
• Public Health
• Spatial Epidemiology

Background:

• Prostate-specific antigen (PSA) testing for prostate cancer is common globally, yet its spatial variation remains understudied, particularly in Sweden.
• Understanding geographical disparities in PSA testing is crucial for equitable healthcare access and resource allocation.

Purpose of the Study:

• To investigate the spatio-temporal variations in prostate-specific antigen (PSA) testing rates among men in the Stockholm region before a prostate cancer diagnosis.
• To identify associations between PSA testing prevalence and socio-economic and demographic factors at municipality and small area levels.

Main Methods:

• A population-based register study analyzing data from men aged 40+ in the Stockholm region (2007-2016).
• Analysis included reporting PSA testing proportions by age groups and calendar years, utilizing spatial smoothing for small area analysis.
• Logistic regression was used to assess the association between country of birth and PSA testing.

Main Results:

• In 2016, a high proportion of men aged 60-79 had undergone PSA testing in the preceding decade (74.0% and 77.8% respectively).
• Significant geographical heterogeneity in PSA testing was observed, with higher rates in municipalities like Danderyd and Ekerö, and within specific small areas.
• Men born in Sweden had a higher odds ratio (2.22) for undergoing PSA testing. Testing prevalence correlated with socio-economic status, including education, income, and country of birth.

Conclusions:

• Opportunistic PSA testing is widespread among older men in the Stockholm region.
• Marked geographical and socio-economic disparities in PSA testing exist, highlighting potential inequities in prostate cancer screening.
• Further research is needed to understand the drivers of these variations and their impact on prostate cancer outcomes.