Associations between socioeconomic factors and PSA testing in a population-based organised testing programme and routine healthcare: a register-based study of 50-year-old men.

Objective: Population-based, organised prostate cancer testing (OPT) programmes were started in Sweden in 2020. The influence of socioeconomic factors on prostate cancer testing in this setting is not known. We examined associations between socioeconomic factors and (1) participation in OPT and (2) unorganised prostate-specific antigen (PSA) testing.

Methods and analysis: Region Västra Götaland's OPT programme invited 21 174 men aged 50 years in 2020-2021. Regional data on unorganised testing in 2013-2014 of men aged 50-52 years were retrieved from Western Sweden Study of Opportunistic Prostate Cancer Screening database. Data on income, education, cohabitation and country of birth were collected from Statistic Sweden. Univariable and multivariable Poisson regression was used to calculate incidence rate ratios (IRRs) with CIs for PSA testing by socioeconomic category.

Results: Participation in OPT was associated with all investigated socioeconomic factors; multivariable IRRs: low versus non-low income 0.63 (95% CI 0.58 to 0.68), single versus non-single household 0.78 (95% CI 0.75 to 0.81), low versus average education 0.84 (95% CI 0.78 to 0.90) and non-Nordic versus Nordic country of birth 0.88 (95% CI 0.84 to 0.92). Unorganised PSA testing was negatively associated with low income 0.83 (95% CI 0.78 to 0.90) and single household 0.87 (95% CI 0.82 to 0.92), but not with low education 1.00 (95% CI 0.92 to 1.08) or non-Nordic country of birth 0.98 (95% CI 0.91 to 1.06).

Conclusion: Socioeconomic factors influenced PSA testing among 50-year-old men, both in an organised testing programme and in unorganised, clinical testing. An active offer of testing is not enough to achieve socioeconomic equality in the early detection of prostate cancer.