To investigate the effects of the U.S. Preventive Services Task Force's (USPSTF) 2012 recommendation against prostate-specific antigen (PSA)-based screening for prostate cancer on survival disparities based on insurance status.
Prior to the USPSTF's 2012 screening recommendation, previous studies found that insured patients with prostate cancer had better outcomes than uninsured patients.
Using the SEER 18 database, we examined prostate cancer-specific survival (PCSS) based on diagnostic time period and insurance status. Patients were designated as belonging to the pre-USPSTF era if diagnosed in 2010-2012 or post-USPSTF era if diagnosed in 2014-2016. PCSS was measured with the Kaplan-Meier method, while disparities were measured with the Cox proportional hazards model.
During the pre-USPSTF era, uninsured patients experienced worse PCSS compared to insured patients (adjusted HR 1.256, 95% CI 1.037-1.520, p = 0.020). This survival disparity was no longer observed during the post-USPSTF era as a result of decreased PCSS among insured patients combined with unchanged PCSS among uninsured patients (adjusted HR 0.946, 95% CI 0.642-1.394, p = 0.780).
Although the underlying reasons are not clear, the USPSTF's 2012 PSA screening recommendation may have hindered insured patients from being regularly screened for prostate cancer and selectively led to worse outcomes for insured patients without affecting the survival of uninsured patients.
BMC urology. 2022 Jun 25*** epublish ***
Isaac E Kim, Daniel D Kim, Sinae Kim, Shuangge Ma, Thomas L Jang, Eric A Singer, Saum Ghodoussipour, Isaac Yi Kim
Warren Alpert Medical School, Brown University, Providence, RI, USA., Department of Biostatistics and Epidemiology, Rutgers School of Public Health, The State University of New Jersey, Piscataway, NJ, USA., Department of Epidemiology and Public Health, Yale University, New Haven, CT, USA., Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA., Department of Urology, Yale School of Medicine, 789 Howard Avenue, Fitkin 307, New Haven, CT, 06520, USA. .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/35752822