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Patterns of prostate‐specific antigen testing by remoteness of residence and socio‐economic status: An Australian population‐based study

Calopedos, Ross J. S., Bang, Albert, Baade, Peter, Yu, Xue Q., Ruthven, Stephen, Patel, Manish I., Smith, David P.
TheAustralian journal of rural health 2019 v.27 no.3 pp. 216-223
Australians, antigen detection, cities, descriptive studies, humans, men, prostate-specific antigen, prostatic neoplasms, regression analysis, rural health, screening, socioeconomic status, Australia
OBJECTIVE: Describes the variation in prostate cancer testing by the remoteness of residence and socio‐economic status groups in Australia. DESIGN: A national population‐based descriptive study using Medicare data extracted by the Department of Health (formerly the Department of Health and Ageing). SETTING: Australia. PARTICIPANTS: All men, with a Medicare‐reimbursed prostate‐specific antigen test conducted in Australia between 2002 and 2017, were included. We focused on “screening and case finding” tests (Medicare Benefits Schedule item number 66655) from 1 April 2005 to 31 December 2009, to describe testing differences in subgroups. Groups were categorised into State and Territory, socio‐economic status and region of residence. A negative binomial regression model was fitted to measure the incidence rate ratios of those who had a screening prostate‐specific antigen test by group. MAIN OUTCOME MEASURES: Age‐standardised testing rates and incidence rate ratios. RESULTS: Between 2002 and 2017, 11 588 775 screening prostate‐specific antigen tests were reimbursed by the Department of Human Services. During 2005‐2009, 52% of all Australian men, aged 40 years and over, had a screening test. The incidence rate ratios differed by State and Territory. Men aged 40 years and over, living in very remote areas, were 43% less likely to have had a screening test than residents of major cities. Prostate‐specific antigen testing rates fell in all age groups between 2007 and 2009 and 2017. CONCLUSIONS: The prostate‐specific antigen testing behaviour differs between community groups in Australia. Men were less likely to have had a screening prostate‐specific antigen test the farther they lived from the major cities. This highlights the need for a more targeted approach to achieve an equitable and evidence‐based prostate cancer care across all sectors of the community.