OBJECTIVES:

To assess sociodemographic variations in prostate specific antigen (PSA) screening outside the U.S. Preventive Services Task Force (USPSTF) recommended age range.

METHODS:

We analyzed 2019 National Health Interview Survey data, allowing analysis of the year immediately following the USPSTF's updated recommendation on PSA screening. We included males who reported having a PSA test in the past year; participants previously diagnosed with prostate cancer, or who reported PSA testing for reasons other than part of a routine exam were excluded. Our outcome reflected USPSTF’s recommended PSA screening ages of 55-69 years (coded as 0) vs. younger/older (coded as 1). Sociodemographics included education, race and ethnicity, income-poverty ratio, health insurance coverage, having a usual place to get preventive care, and a 5-year mortality risk estimate. We used logistic regression for the analysis.

RESULTS:

The final weighted sample consisted of 17,417,715 male respondents (mean [SD] age = 64.0 [10.2] years), most of whom were White (76.2%) and had an income-poverty ratio level above 2 (84.6%).

The logistic regression results show a decreased likelihood of PSA screening outside the recommended age range for the following groups: Asian compared to White participants (OR=0.49, 95%CI: 0.27-0.88); participants who had completed high school (OR=0.60, 95%CI: 0.45-0.80) or some college (OR=0.76, 95%CI: 0.60-0.97) compared to those who had completed a 4-year college degree or higher; and individuals with lower income-poverty ratios (OR: 0.62, 95%CI: 0.44-0.89) compared to higher ratios. Conversely, those with 5-year mortality index estimates of 12% (OR=1.52, 95%CI: 1.08-2.14), 19% (OR=2.68, 95%CI: 1.72-4.16), 29-37% (OR=3.64, 95%CI: 2.43-5.47), and 49-62% (OR=9.59, 95%CI: 5.71-16.12) had a higher likelihood of age ineligible screening compared to those with a lower (5%) 5-year mortality estimate.

CONCLUSIONS:

Our analysis shows disproportionate use of PSA screening outside the USPSTF recommendation among males with higher levels of education, income, and mortality risk estimates.