Prostate Cancer Screening Among Traditionally Underserved Populations at a Large Public Safety-Net Institution

Existing literature underscores racial and sociodemographic disparities in prostate cancer screening (PCS) in the USA.

To evaluate whether traditional PCS disparities are evident within a health safety-net institution tailored to support traditionally underserved populations.

A retrospective cohort study using electronic health-record data was conducted at an urban safety-net institution.

Male patients aged 51-70 years with a primary care provider (PCP) visit from 2018 to 2019 were included.

The primary outcome was PCS, defined as receiving a Prostate Specific Antigen (PSA) blood test within the study period. Investigated patient characteristics included self-reported race and ethnicity, language, insurance, marital status, median household income, serious mental illness (SMI), substance use disorder (SUD), and family history of prostate cancer (PCa). Bivariate analyses using chi-squared tests and multivariable logistic regression analyses were performed to compare PCS rates between the groups.

The cohort included 10,059 men, of which 40.4% had PCS. In total, 57.3% of the study population was of non-White race and 61.4% of non-North American/European ethnicity. A total of 31.2% had limited English proficiency (LEP), 17.8% had SMI, and 13.2% had SUD. In multivariable analysis of race, Black patients (OR 1.96, 95%CI 1.71-2.24, p < 0.001) and Hispanic patients (OR 1.51, 95%CI 1.3-1.76, p < 0.001) had significantly higher odds of PCS than White patients. Patients with LEP did not exhibit significantly lower screening rates than English-speaking patients (ORs 0.99-1.17).

Within a healthcare institution designed and implemented to meet the needs of underserved populations, traditional racial and sociodemographic disparities in PCS are not evident.