Prostate cancer screening behaviors among U.S. immigrants: a cross-sectional analysis using the NHIS database
Nathaniel F. Hansen, BS1, Joshua A. Linscott, MD, PhD2, Matthew H. Hayn, MD2, Stephen T. Ryan, MD2, Jesse Sammon, DO2.
1Tufts University School of Medicine, Boston, MA, USA, 2Maine Medical Center Division of Urology, Portland, ME, USA.
Background: Immigrants constitute 14% of the U.S. population, but structural barriers and immigrant-specific characteristics make this group especially vulnerable to poor healthcare access. Prior research demonstrates U.S. immigrants have low rates of guideline-concordant breast and colorectal screening. Furthermore, male patients with limited English proficiency are more likely to be diagnosed with advanced stage genitourinary cancers. The shared decision-making model of prostate specific antigen (PSA) screening poses a unique challenge to immigrants, especially those with barriers to longitudinal care and English proficiency. Together, these data suggest that immigrants may experience significant inequity in access to and receipt of high-quality prostate cancer screening. The goal of this study was to characterize screening behaviors among U.S. immigrants and to identify specific mechanisms to enhance guideline-concordant PSA-based screening for U.S. immigrants.Methods: Data was obtained from the National Health Interview Survey (NHIS). Descriptive statistics were used to characterize the sociodemographic features of immigrants versus the U.S.-born population. Complex samples logistic regression was performed to assess the relationship between immigrant-specific characteristics including region of birth, citizenship status, length of residence within the U.S., English language proficiency, and history of PSA screening.Results: Immigrants were less likely than the U.S.-born population to have been screened for prostate cancer (aOR = 0.76; 95% CI = 0.65-0.88). Citizenship status, length of residence in the U.S., and English proficiency were directly linked to increased rates of PSA screening. There was significant variability in PSA screening for immigrants based on region of origin with Asian immigrants having the lowest rate of PSA screening. Increasing annual physician visits and expanding interpreter services were identified as modifiable mechanisms to improve prostate cancer screening among the U.S. immigrant population. Among U.S. immigrants, seeing a physician within the last 12 months led to a nearly three-fold increase in the odds of receiving screening for prostate cancer (aOR = 2.81; 95% CI = 2.11-3.72). English language proficiency led to a two-fold increase in the odds of receiving screening for prostate cancer (aOR = 1.97; 95% CI = 1.41-2.76).Conclusions: This study demonstrated that immigrants have low rates of prostate cancer screening compared to the native-born U.S. population. Though the prevalence of prostate cancer overdiagnosis implies that universal PSA screening is not inherently desirable, the disproportionately low rate of PSA testing among U.S. immigrants is demonstrative of an approach to cancer prevention that does not adequately meet the needs of this marginalized population. Improving healthcare utilization and language services can make urologic cancer screening more equitable for U.S. immigrants.
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