Socioeconomic Status and Prostate-specific Antigen Testing: A Population-based Cohort Study Comparing Organised and...

Area of Science:

• Urology
• Public Health
• Health Services Research

Background:

• Socioeconomic disparities are well-documented in opportunistic prostate-specific antigen (PSA) testing for prostate cancer (PCa).
• Organised prostate cancer testing (OPT) programs aim to improve screening access and equity.

Purpose of the Study:

• To evaluate if the introduction of OPT in Stockholm County reduced socioeconomic disparities in PSA testing.
• To compare PSA testing associations with socioeconomic status between invited and ineligible men.

Main Methods:

• A register-based cohort study included men invited to OPT (n=33,754) and a concurrently ineligible control group (n=76,535).
• Logistic regression analyzed associations between socioeconomic indicators (education, income, civil status, birth country) and PSA testing.
• Z tests compared these associations between the OPT invitee and ineligible cohorts.

Main Results:

• OPT increased overall PSA testing (39% vs. 13%).
• Higher education was linked to increased testing in OPT invitees (OR 1.88) but not ineligible men (OR 1.03).
• Income disparities persisted, with higher income associated with increased testing in both groups, particularly the ineligible group.

Conclusions:

• Organised prostate cancer testing (OPT) enhanced overall PSA testing rates but did not eliminate socioeconomic disparities.
• Targeted strategies are essential to ensure equitable participation in prostate cancer screening programs.
• Further research should address potential residual confounding factors influencing testing disparities.