Multidimensional Healthcare Access Barriers to Prostate-Specific Antigen Testing: A Nation-Wide Panel Study in the United States From 2006 to 2020

IF 2.9 2区医学 Q2 ONCOLOGY

Cancer Medicine Pub Date : 2024-11-06 DOI:10.1002/cam4.70358

Hari S. Iyer, Kevin H. Kensler, Charlotte Roscoe, Chidinma Opara, Mingchao He, Evan Kovac, Isla P. Garraway, Quoc Dien-Trinh, Timothy R. Rebbeck

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引用次数: 0

Abstract

Background

Rising metastatic prostate cancer incidence has renewed debate regarding benefits of prostate-specific antigen (PSA) screening. Identifying barriers to accessing screening for individuals at high risk of lethal prostate cancer may slow this rise. We examined associations of access barriers with receipt of PSA testing, stratified by sociodemographic factors.

Methods

We pooled data from male respondents to Behavior Risk Factor Surveillance Systems (BRFSS) surveys from 2006 to 2020. Questions related to affordability (insurance, cost of visits) and accommodation (regular primary care provider (PCP), physician recommending a PSA test) were considered as individual-level barriers. For availability, we linked provider density from the 2012 Area Health Resource File and estimated driving times to closest health facility within Micropolitan and Metropolitan Statistical Area (MMSA) using Google Earth Engine. These measures were used to compute a spatial accessibility index. We fit survey-weighted, covariate-adjusted logistic regression models to estimate associations of barriers with receipt of PSA within the past 2 years and examined effect modification by sociodemographic factors.

Results

There were 185,643 participants, of whom 73% were White, 11% were Black, 4% were Asian, and 11% were Hispanic. Physician recommendation was the strongest predictor of having a PSA test (aOR: 14.5, 95% CI: 13.6, 15.6). Not having a regular PCP (aOR: 0.29, 95% CI: 0.27, 0.31), insurance (aOR: 0.64, 95% CI: 0.58, 0.71), and prohibitive cost of care (aOR: 0.82, 95% CI: 0.75, 0.90) were associated with lower PSA testing. Access barriers were stronger predictors of PSA testing for Asian and White participants compared to other groups (P_het < 0.004 for insurance and regular PCP) and for those with college education compared to those without (P_het < 0.05 for insurance, perceived unaffordability).

Discussion

Physician recommendation was the strongest predictor of receipt of PSA testing, regardless of sociodemographic grouping. Future studies should consider access barriers jointly and across sociodemographic strata.

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前列腺特异性抗原检测的多维医疗访问障碍：2006 至 2020 年美国全国小组研究》。

背景：转移性前列腺癌发病率的上升再次引发了有关前列腺特异性抗原（PSA）筛查益处的争论。找出致命性前列腺癌高危人群接受筛查的障碍可能会减缓发病率的上升。我们研究了接受 PSA 检测的障碍与社会人口因素的关联：我们汇总了 2006 年至 2020 年行为危险因素监测系统 (BRFSS) 调查中男性受访者的数据。与可负担性（保险、就诊费用）和便利性（固定的初级保健提供者 (PCP)、推荐进行 PSA 检测的医生）相关的问题被视为个人层面的障碍。在可获得性方面，我们将 2012 年地区卫生资源档案中的医疗服务提供者密度与谷歌地球引擎估算的到大都市和都市统计区 (MMSA) 内最近医疗机构的驾车时间联系起来。这些指标用于计算空间可及性指数。我们拟合了经过调查加权、协变量调整的逻辑回归模型，以估算障碍与过去两年内接受 PSA 的相关性，并研究了社会人口因素对影响的修正作用：共有 185,643 名参与者，其中 73% 为白人，11% 为黑人，4% 为亚裔，11% 为西班牙裔。医生建议是预测进行 PSA 检测的最有力因素（aOR：14.5，95% CI：13.6，15.6）。没有固定的初级保健医生（aOR：0.29，95% CI：0.27，0.31）、没有保险（aOR：0.64，95% CI：0.58，0.71）以及医疗费用过高（aOR：0.82，95% CI：0.75，0.90）与较少进行 PSA 检测有关。与其他群体相比，亚裔和白人参与者接受 PSA 检测的障碍更大（Phet het 讨论）：无论社会人口组别如何，医生推荐是接受 PSA 检测的最强预测因素。未来的研究应综合考虑不同社会人口阶层的获取障碍。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.