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

Socioeconomic disparities in opportunistic prostate-specific antigen (PSA) testing for prostate cancer (PCa) are well known. To explore whether the introduction of organised prostate cancer testing (OPT) was associated with reduced disparities, we compared associations between socioeconomic status and PSA testing among invited and ineligible men.

A register- and population-based cohort study was conducted including all men in Stockholm County invited to OPT in 2022-2023 (OPT invitees, aged 50 yr, born in 1972-1973) and a concurrently ineligible control group (OPT ineligible, aged 52-53 yr, born in 1969-1971). A sensitivity analysis included men aged 50-51 yr in 2017-2018 (born in 1966-1968). Associations with PSA testing were analysed using logistic regression, with educational level, civil status, income, and birth country/region as socioeconomic indicators. Z tests compared associations between cohorts.

A total of 33 754 OPT invitees and 76 535 OPT-ineligible men were included. PSA testing was higher among OPT invitees (39%) than among OPT-ineligible men (13%) across all socioeconomic strata. In adjusted models, higher education was associated with increased testing among OPT invitees (odds ratio [OR] 1.88, 95% confidence interval [CI] 1.73-2.06), but not among OPT-ineligible men (OR 1.03, 95% CI 0.94-1.12; p < 0.001). Income was associated with increased testing in both groups, particularly among OPT-ineligible men (OR 3.56, 95% CI 3.28-3.87 compared to 2.18, 95% CI 2.01-2.37; p = 0.006). Being born outside the Nordic countries was associated with lower uptake among OPT invitees. The sensitivity analysis aligned with the main findings. Limitations include potential residual confounding.

While OPT increased PSA testing overall, socioeconomic disparities persisted. Targeted strategies are needed to ensure equitable participation.