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

Introduction

Cancer screening choices may be influenced by more complex interactions of known social determinants of health (SDOH) including race, socioeconomic status (SES), and general health behaviors. In addition to SDOH, shared decision-making (SDM), required for responsible, guideline-concordant prostate-specific antigen (PSA) testing for prostate cancer screening, may augment screening rates. This study assesses the influence of SDOH and SDM on PSA screening rates.

Materials

Responses of individuals meeting the eligibility criteria for PSA screening based on current recommendations were extracted from the 2020 Behavioral Risk Factors Surveillance Survey (BRFSS). Records containing definitive history of SDM and PSA testing were included for analysis. Hierarchical classification of records was used to identify similar clusters. Multivariable interactions were calculated. All results were weighted.

Results

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Four distinct clusters were identified within the 30,958 records that met inclusion criteria (Table 1): less diverse, low SES (LD-LS); less diverse, high SES (LD-HS); more diverse, low SES (MD-LS); more diverse, high SES (MD-HS). Rates of SDM were similar: 22% in LD-LS, 23.36% in LD-HS, 20.34% in MD-LS, 19.9% in MD-HS. For the four groups, LD-LS, LD-HS, MD-LS, and MD-HS, PSA screening rates were significantly different with 48.6%, 49.5%, 39.59%, and 39.52%, respectively; colorectal carcinoma screening rates were similar with 81.6%, 84.1%, 78.5%, and 77.2%, respectively. SDM increased odds of PSA testing in all groups, MD-LS demonstrated the highest increase (OR=4.64, CI=4.63 –  4.65), followed by MD-HS (OR=3.69, CI=3.68 – 3.69), LD-LS (OR=3.21, CI=3.21 – 3.21), and LD-HS (OR=3.06, CI=3.06 – 3.06).

Conclusion

Naturalistic analysis identified unique groups with distinct healthcare behaviors representing differences between PSA screening-eligible patients. SDOH and preventative health behaviors interact with SDM, which remains low across all groups, and affect cancer screening rates. Importantly, differences in SDM and PSA screening exist within the same racial groups when considering SES and within the same SES level when considering race. Additional investigation into the interplay of SDOH and lifestyle can further elucidate how cancer screening practices may be improved.

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