Multilevel Small Area Estimation of Prostate-Specific Antigen Screening Test in the United States by Age Group: 2018 Behavioral Risk Factor Surveillance System

Abstract

Background: In 2018, the US Preventive Services Task Force (USPSTF) recommended prostate cancer screening for men aged 55 to 69 years who express a preference for being screened after being informed about and understanding prostate-specific antigen (PSA) test benefits and risks. USPSTF recommended against screening men aged ≥70 years. We aim to generate county-level prevalence estimates, masked by national and state estimates, to identify counties with high PSA screening prevalence.Methods: We fitted multilevel logistic regression mixed models for 4 age groups (≥40, 40 to 54, 55 to 69, ≥70 years), using data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 116,654) and other sources. We evaluated consistency between our model-based state and BRFSS direct state estimates with Spearman and Pearson correlation coefficients.Results: PSA screening prevalence increased with increasing age groups: 7.7% for men aged 40 to 54 years, 27.2% for men aged 55 to 69 years, and 33.7% among men age ≥70 years, and was largely clustered in the South and Appalachia. Many county estimates among men aged ≥70 years exceeded 40%, especially in the South. Correlation coefficients were 0.94 for men aged ≥40, and ≥0.85 for men aged 40 to 54 years, 55 to 69 years, and ≥70 years.Conclusions: PSA screening was highest among men ≥70 years, for whom it is not recommended, and in the South among all age groups. Screening varied substantially within states.Impact: In 2018, on average, more than 1 in 4 men aged 55 to 69 years and 1 in 3 men aged ≥70 years underwent PSA screening in the prior year, suggesting potential overuse among some men.

Access to Prostate-Specific Antigen Testing and Mortality Among Men With Prostate Cancer

“…County-level estimates of PSA testing, which reflect availability of and physical accessibility to screening, were estimated using a previously validated approach for extrapolating prevalence estimates of health behaviors from the Behavioral Risk Factor Surveillance System (BRFSS) to the total US population using a multilevel mixed-effects model and poststratification weights. 36 , 37 , 38 , 39 In brief, the BRFSS is a telephone-based survey conducted annually among US adults to monitor state and national trends in health-related behaviors and use of preventive services. Questions about PSA screening (whether self-identified male respondents ever received a PSA test, and how long ago the test was conducted) were asked in even-numbered years.…”