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Prostate cancer screening increased for men aged 55-69 after updated guidelines, but gains were smaller in socioeconomically disadvantaged areas. This highlights potential barriers to equitable screening access.

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Area of Science:

  • Public Health
  • Health Services Research
  • Preventive Medicine

Background:

  • The US Preventive Services Task Force (USPSTF) updated prostate cancer screening recommendations in 2018 for men aged 55-69 years.
  • The update shifted from discouraging screening (Grade D) to supporting individualized decision-making (Grade C).
  • Previous studies on screening changes were limited to privately insured populations.

Purpose of the Study:

  • To assess changes in prostate cancer screening rates following USPSTF recommendation revisions in Colorado.
  • To examine variations in screening changes by payer type (e.g., Medicare, commercial).
  • To investigate the influence of area-level social determinants of health on screening trends.

Main Methods:

  • Utilized Colorado's All-Payer Claims Database for men aged 55-69 with continuous annual enrollment (2014-2023).
  • Employed negative binomial regression models to estimate changes in screening procedures, adjusting for covariates and clustering at the Zip Code Tabulation Area level.
  • Stratified analyses by payer and examined associations between screening changes and the social deprivation index.

Main Results:

  • Overall screening rates increased from 23.1% in 2014 to 32.1% in 2023 across all payers.
  • The largest increases in screening were observed among Medicare Advantage and commercially insured enrollees.
  • Geographic variations showed smaller screening gains in areas with higher deprivation, including poverty, low educational attainment, and crowded housing.

Conclusions:

  • Prostate cancer screening uptake increased post-recommendation revisions across diverse payer groups.
  • The magnitude and trajectory of screening increases varied, suggesting differential access.
  • Socioeconomic factors appear to present barriers to prostate cancer screening among eligible and insured men.