Prostate-specific antigen test use reported in the 2000 National Health Interview Survey
Introduction
Although there is no scientific consensus that screening with the prostate-specific antigen (PSA) test reduces deaths from prostate cancer, and the debate is ongoing as to whether the potential benefits of screening outweigh the possible harms [1], [2], [3], [4], [5], [6], the PSA test is commonly used [7], [8], [9], [10], [11], [12]. Medicare claims data [9], [13], and surveys of clinicians [14], [15], [16], and men [7], [9], [10], [11], [13], [17], [18], [19] in certain U.S. geographic areas or health care systems indicate that PSA testing increased during the 1980s and 1990s.
Although use has increased, there is limited published information about the prevalence of PSA test use in subpopulations of men defined by demographic or social characteristics that may influence use of PSA tests; additionally, studies do not routinely distinguish between PSA tests done for screening and other purposes. Many studies are specific to a particular region or clinic, have small samples, or are not population-based [9], [10], [11], [12], [13], [14], [17], [18], [19], [20], [21], [22], [23], [24], [25]. Factors related to use of PSA testing and/or use of digital rectal examination (DRE) include age [11], [20], [21], [26], race/ethnicity [13], [14], [17], [18], [19], [22], [26], income/poverty status [17], [19], [21], [23], [26], immigrant status [26], education [12], [20], [26], health insurance status [12], [26], [27], having a regular source of healthcare [12], [21], [26], marital status [23], prior prostate screening history [23], family history of prostate cancer [24], history of urinary tract symptoms [23], [25], other illnesses [7], [21], and health behaviors such as exercise and diet [11].
The 2000 National Health Interview Survey (NHIS) provides information about PSA test use among a nationally representative sample of U.S. men [26]. Our study uses these data to provide the first detailed examination of PSA use in a nationally representative sample of U.S. men. Its main purposes were to (1) examine the prevalence of annual PSA screening and routine test use; (2) describe use among subgroups defined by three sets of characteristics: factors found to be related to PSA test use in earlier research, factors reported to influence use of cancer screening tests in women, and some specific health-related factors that might influence decisions about PSA test use; and (3) examine use adjusted for other factors that may affect use.
Section snippets
Study methods
The NHIS is an annual health survey conducted by the National Center for Health Statistics [28]. The survey includes core questions about the respondent's health, demographic and socioeconomic circumstances, and access to and use of health services. It also contains one or more annual supplements addressing particular health issues. In 2000, the survey collected information related to cancer prevention and control [26]. One sample adult was randomly selected from each family participating in
Study population
Interviews were conducted with 32,374 adults in 39,264 families. In 7,784 families, there were no adult males in residence. The adult sample response rate was 72.1%. Our analysis focused on men aged 50 and older because most organizations that support prostate cancer screening recommend that annual testing begin at age 50 [29]. Because African-American men and men with a family history of prostate cancer are at higher risk at younger ages, some organizations recommend offering PSA testing at an
Data collection
Male respondents aged 40 and older were asked if they had heard of the PSA test, and if so, whether they had one, and if they had, when their most recent test was and the reason for it. They were also asked how many tests they had received in the last 5 years. From those questions, we created four PSA test use measures indicating (1) if a man had ever had a PSA test, (2) if he had had a test in the previous year, (3) if he had had a recent PSA test for screening purposes (as a “routine test” or
Data analysis
The NHIS used a stratified, multistage-cluster sample [28]. The statistical program SUDAAN was used in all of our analyses to account for this sampling [34]. The SUDAAN analyses used sample weights provided with the NHIS public use data file to adjust for the complex, cluster sampling, and over-sampling. Further, the analyses were weighted (“post-stratified”) to the U.S. census distributions by age and race/ethnicity for the year 2000 to provide estimates representative of U.S. men in the
Results
The distribution of characteristics of the NHIS sample of men aged 50 and older (Table 1) reflected patterns in the U.S. population in 2000 [28], after adjustment for sampling methods and weighting to U.S. census distributions by age and race/ethnicity.
Use of the PSA test for screening purposes was more common among men who were aged 65–79, non-Hispanic and U.S. born (Table 2). Screening PSA test use tended to be higher among men with higher levels of socioeconomic status, that is, those with
Discussion
Approximately one-third (34%) of men aged 50 and older interviewed in the 2000 NHIS had had a screening PSA test during the last year, despite the uncertainty about the benefits of screening. By comparison, 31% of men aged 50 and older in the 2000 NHIS had received a screening endoscopy within the previous 5 years or a fecal occult blood test (FOBT) within the previous year, the recommended intervals for colorectal cancer screening tests. Thus, PSA test use for screening is as common as
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