Presented by: Borivoj Golijanin
Minimally Invasive Urology Institute of the Miriam Hospital and Warren Alpert Medical School of Brown University

Introduction

Social determinants of health (SDOH) have been well documents to be a barrier to equal and quality healthcare. In prostate cancer in America, racial disparities are associated with higher incidence and mortality in black men compared to white men. It is unclear if this disparity exists at the level of prostate cancer screening with prostate-specific-antigen (PSA) testing and shared-decision-making (SDM), a requirement in guidelines for prostate cancer screening.

Materials

This study identifies men aged 50-75 in the 2020 Behavioral Risk Factor Surveillance Survey and assesses how SDOH influence the likelihood of PSA testing and SDM.

Results

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54,396 respondents with average age of 62 at time of responding to the survey were included. 62% of respondents had PSA testing. Patients who had PSA testing identified as: 81. 3% White, 7.6% Black, 6.6% Hispanic, 1.6% Asian, 1.1% Multiracial, 0.8% American Indian/Pacific-Islander, 0.2% Native Hawaiian, and 1.1% Other.  For every year older than 50, odds of PSA testing increased (AOR=1.03, CI=1.03 - 1.03). Any level of college education was found in 85.3% of individuals with SDM, and in 79.2% of those without had; in 85.5% of those with history of PSA testing, and in 76.7% of those without PSA testing. Any college-level education was associated with higher odds of SDM (AOR=1.93, CI=1.92 – 1.94) and PSA screening (AOR=3.38, CI=3.36 – 3.39). Compared to White, Black patients had higher odds of SDM (AOR=1.6, CI=1.59 – 1.6)  and decreased odds of PSA testing (AOR=0.94, CI=0.94 – 0.95). Hispanic patients had increased odds of SDM (AOR=1.16, CI=1.15 – 1.16) and PSA screening (AOR=1.05, CI=1.05 – 1.06). Compared to residents of the Northeastern United States, there were lower odds of SDM and PSA testing in the Western US, Southern US, and Midwestern US.

Conclusion

SDOH mediate the likelihood of SDM and PSA testing in age eligible men. Specifically, racial disparities suggest that Black men undergo PCa screening at lower rates. These findings suggest that higher incidence and mortality in this patient population might be related to screening efforts. Improving the quality of SDM in this patient population can improve prostate cancer detection.

Funding

None.

Lead Authors

vikas bhatt,
Minimally Invasive Urology Institute of the Miriam Hospital and Warren Alpert Medical School of Brown University

Co-Authors

Alexander Homer,
Minimally Invasive Urology Institute of the Miriam Hospital and Warren Alpert Medical School of Brown University

Gyan Pareek,
Minimally Invasive Urology Institute of the Miriam Hospital and Warren Alpert Medical School of Brown University

Elias Hyams,
Minimally Invasive Urology Institute of the Miriam Hospital and Warren Alpert Medical School of Brown University