Socioeconomic disparities in prostate cancer screening: the impact of the Area Deprivation Index on PSA screening frequency.

Abstract

To investigate the impact of the Area Deprivation Index (ADI) on prostate-specific antigen (PSA) screening patterns in a North American cohort, as the influence of neighbourhood socioeconomic disadvantage on prostate cancer screening intensity has been scantly analysed. We included all men receiving care in Henry Ford Health System, aged 50-69 years and without previous prostate cancer diagnosis at the 31 December 2022. Each patient was assigned an ADI score based on their census block group, categorised into quartiles, with the fourth quartile (Q4, ADI 75-100) representing the most disadvantaged areas. The screening rate was calculated as the total number of PSA tests divided by the number of years patients were aged 50 years and older. Multivariable Poisson regression analysis tested the ADI's influence on screening rate. Among the 266 203 patients initially included, 75 958 patients had at least one PSA test at our institution. Overall, 20.9% were non-Hispanic Black. Patients in the most disadvantage quartile (Q4) were more likely to be non-Hispanic Black (P < 0.001), had higher comorbidity rates (P < 0.001) and lower probability of receiving two or more PSA tests (P < 0.001) compared to the ones in the least disadvantaged quartile (first quartile [Q1]). At Poisson regression analysis, when compared to patients in Q4, patients from Q1, and the second and third quartile had a 1.87-, 1.70-, and 1.52-fold higher probability of receiving screening, respectively (P < 0.001). Living in more deprived areas was associated with lower rates of PSA screening frequency. These findings highlight how socioeconomic deprivation may limit access to preventive healthcare, reinforcing the need for more inclusive and targeted outreach strategies.