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Published on: March 6, 2018
Disability Status and Prostate Cancer Screening Among US Men Aged 55 to 69 Years
José I Nolazco1,2, Lisa I Iezzoni3,4, Eugene C Chen5
1Department of Urology, Mass General Brigham, Harvard Medical School, Boston, Massachusetts.
Importance:
People with disabilities experience persistent inequities in preventive care, yet contemporary, nationally representative data on prostate-specific antigen (PSA) testing disparities are limited.
Objective:
To evaluate the association between disability status and self-reported PSA testing among US men aged 55 to 69 years.
Design, Setting, And Participants:
This cross-sectional study used 2023 data from the Behavioral Risk Factor Surveillance System (BRFSS), a US population-based telephone survey. The analytic sample included 10 508 male respondents aged 55 to 69 years with complete PSA testing and disability data; analyses incorporated BRFSS survey weights to generate nationally representative estimates. Data were analyzed from October 2024 to May 2025.
Exposures:
Any disability and disability types (mobility, cognitive, hearing, vision, self-care, independent living) measured using the standard 6-question sequence.
Main Outcomes And Measures:
The main outcome was self-reported PSA testing, assessed using BRFSS PSA items. Survey-weighted logistic regression was used to estimate adjusted odds ratios (AORs), controlling for sociodemographic factors, insurance, comorbidities, and health behaviors, with multiple imputation for missing covariates.
Results:
The weighted analytic sample represented 5 058 866 US men aged 55 to 69 years; 29.6% reported at least 1 disability. Overall, 62.7% (95% CI, 61.1%-64.3%) reported prior PSA testing, with lower testing among men with disabilities than among those without (57.2% [95% CI, 54.2%-60.2%] vs 65.1% [95% CI, 63.2%-67.0%]; P < .001). In adjusted survey-weighted models, disability was associated with lower odds of PSA testing (AOR, 0.83; 95% CI, 0.69-0.99). Among disability types, mobility disability was associated with lower testing (AOR, 0.77; 95% CI, 0.62-0.96). In an unweighted sensitivity analysis, the association between any disability and lower PSA testing remained significant (AOR, 0.86; 95% CI, 0.77-0.98).
Conclusions And Relevance:
In this nationally representative cross-sectional study of US men aged 55 to 69 years, disability status was associated with lower PSA testing, with the most consistent disparity observed among men with mobility disability. These findings suggest disability, particularly mobility impairment, may be an under-recognized determinant of preventive care and may warrant targeted interventions to improve equitable access to shared decision-making and screening services.
