ASPO Abstracts
Disparities in prostate-specific antigen testing by race and ethnicity in the All of Us Research Program
Category: Early Detection & Risk Prediction
Conference Year: 2023
Abstract Body:
Purpose: Given the large differences in prostate cancer incidence and mortality across racial and ethnic groups in the U.S., we sought to describe disparities in prostate-specific antigen (PSA) testing within the All of Us (AoU) Research Program. Methods: AoU is a nationwide cohort study intended to accelerate biomedical breakthroughs for populations that have been traditionally underrepresented in medical research. Within AoU, we identified a cohort of 41,250 males ages 40-85 without a history of prostate cancer or prostatic disease at time of enrollment who had at least one condition, observation, or procedure code in their linked electronic health record (EHR). PSA tests were identified using CPT, LOINC, and SNOMED codes in the linked EHR data from study enrollment in 2017-2021 through the end of follow-up in 2021. Incidence rate ratios (IRR) for the number of PSA tests received over follow-up were estimated using negative binomial regression models, adjusting for factors that influence healthcare access and utilization. The proportion of men in AoU who received a PSA test within two years was compared against estimates from the 2020 Behavioral Risk Factor Surveillance System (BRFSS). Results: A total of 6,421 participants (15.6%) received a PSA test over the follow-up period. Age, education, employment, insurance status, income, housing, family history of prostate cancer, body mass index, and geographic region were all associated with PSA testing rates in multivariable-adjusted models. In multivariable-adjusted models, non-Hispanic Black men had 22% fewer PSA tests (IRR=0.78, 95% CI 0.72-0.85), while rates did not significantly differ for other racial and ethnic groups, relative to non-Hispanic White men. The proportion of men receiving a PSA test within two years was lower in AoU relative to the BRFSS for non-Hispanic Black (8.2% AoU vs 24.1% BRFSS), Hispanic (9.4% vs 23.4%), non-Hispanic Asian/Pacific Islander (14.5% vs 19.4%) and non-Hispanic White (16.2% vs. 29.5%) men. Conclusion: In the AoU Research Program, PSA testing rates were lower among non-Hispanic Black men relative to men of another race or ethnicity. Testing frequencies in AoU were substantially lower than population-level estimates, in part reflecting incompleteness of the AoU EHR data.
Keywords: prostate-specific antigen testing; prostate cancer; screening; All of Us Research Program