Original Article

Clinical Research

The impact of sociodemographic factors and PSA screening among low-income Black and White men: data from the Southern Community Cohort Study

  • Prostate Cancer and Prostatic Diseases volume 20, pages 424429 (2017)
  • doi:10.1038/pcan.2017.32
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Received:
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Abstract

Background:

Variation in PSA screening is a potential source of disparity in prostate cancer survival, particularly among underserved populations. We sought to examine the impact of race and socioeconomic status (SES) on receipt of PSA testing among low-income men.

Methods:

Black (n=22 167) and White (n=9588) men aged 40 years completed a baseline questionnaire from 2002 to 2009 as part of the Southern Community Cohort Study. Men reported whether they had ever received PSA testing and had testing within the prior 12 months. To evaluate the associations between SES, race and receipt of PSA testing, odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from the multivariable logistic models where age, household income, insurance status, marital status, body mass index and educational level were adjusted.

Results:

Black men were younger, had a lower income, less attained education and were more likely to be unmarried and uninsured (all P<0.001). Percentages of men having ever received PSA testing rose from <40% under the age of 45 years to ~90% above the age of 65 years, with Whites >50 more likely than Blacks to have received testing. Lower SES was significantly associated with less receipt of PSA testing in both groups. After adjustment for SES, White men had significantly lower odds of PSA testing (OR 0.81; 95% CI: 0.76–0.87).

Conclusions:

Greater PSA testing among White than Black men over the age of 50 years in this low-income population appears to be mainly a consequence of SES. Strategies for PSA screening may benefit from tailoring to the social circumstances of the men being screened.

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Acknowledgements

This work was supported by NIH Grants RO1CA92447, NCI/NIH 2P30CA068485-19 and NCI 5K12CA090625-14. The SCCS is supported by NIH Grants R01 CA092447 and U01 CA202979, and the Survey and Biospecimen Shared Resource, which is supported in part by the Vanderbilt‐Ingram Cancer Center (P30 CA68485).

Author contributions

KAM: Planning and conducting the study, reporting and overall guarantor; ZZ: planning and conducting the study, reporting and overall guarantor; YB: reporting; JA: reporting; AH: reporting; WJB: planning and conducting the study, reporting and overall guarantor; JHF: planning and conducting the study, reporting and overall guarantor.

Author information

Author notes

    • K A Moses
    •  & Z Zhao

    These authors contributed equally to this work.

Affiliations

  1. Department of Urologic Surgery, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA

    • K A Moses
    •  & J H Fowke
  2. Department of Biostatistics, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA

    • Z Zhao
    •  & Y Bi
  3. Meharry Medical College, Nashville, TN, USA

    • J Acquaye
    •  & A Holmes
  4. Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA

    • W J Blot
    •  & J H Fowke

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Competing interests

Dr Moses is a member of the NCCN Guidelines Panel on Early Detection of Prostate Cancer, and is on the Speakers’ Bureau of Astellas/Medivation. The other authors declare no conflict of interest.

Corresponding author

Correspondence to K A Moses.