The combined number of men in the sample was 16,058. The large majority of these men were non-Hispanic white, married, had health-care coverage and a usual source of health care, and had seen a doctor within the past year (). For the recent-screening outcome (having had a screening PSA test in the past two years), we noted statistically significant differences across categories within year, age, race/ethnicity, marital status, education and income levels, geographic region, BMI, number of chronic diseases, family history of cancer, having health-care coverage, having a usual place of health care, and having seen a doctor in the past year.
For the frequent-testing outcome (having had three or more PSA tests in the past five years), differences across categories within variables were similar to the recent-screening outcome, except for self-reported physical health, which was found to be significant for this variable, and income, which was not significant ().
examines both outcomes by year to determine trends by specific characteristics. From 2000 to 2005, we noted variations in receipt of a recent screening PSA test for the variable marital status. Recent screening PSA tests declined in the single, never-married category from 20.6% in 2000 to 15.2% in 2005, while use among those married increased from 29.9% to 32.6% in the same periods.
Comparison of 2000 and 2005 trends in PSA test use among men ≥40 years of age: NHIS 2000 and 2005
Similarly, the receipt of three or more PSA tests in the past five years increased among those with a known family history of prostate cancer and those who had seen a doctor in the past year, while remaining relatively stable among those without these characteristics. For this outcome, no other variables were found to differ significantly from 2000 to 2005.
After adjusting for all characteristics in the multivariate model (), higher odds of having had a recent PSA screening were associated with being 50–64 years of age (OR=3.94; 95% CI 3.46, 4.49), 65–79 years of age (OR=6.74; 95% CI 5.73, 7.93), and ≥80 years of age (OR=4.09; 95% CI 3.18, 5.26); black race/ethnicity (OR=1.35; 95% CI 1.13, 1.61); higher levels of education and income; living in the southern region of the U.S. (OR=1.31; 95% CI 1.13, 1.51); good and better self-reported health status; two or more chronic diseases (2000) and one or more chronic diseases (2005); having a family history of prostate cancer (2000) (OR=1.97; 95% CI 1.63, 2.39); having a usual place of health care (OR=2.20; 95% CI 1.74, 2.80); and having seen a doctor in the past year (OR=2.81; 95% CI 2.48, 3.18). Non-Hispanic men of other race/ethnicity (OR=0.73; 95% CI 0.55, 0.95), widowed men (OR=0.75; 95% CI 0.59, 0.95), never-married men (2005) (OR=0.59; 95% CI 0.46, 0.76), and men without health-care coverage (OR=0.54; 95% CI 0.43, 0.68) had lower odds of having had a recent screening compared with their referents.
Multivariate logistic regression model of PSA test use among men ≥40 years of age with no prostate cancer, NHIS 2000 and 2005
Results for the frequent-testing outcome (having had three or more PSA tests in the past five years) mirrored those for the recent-screening outcome (having had a screening PSA test in the past two years) with a few exceptions. Frequent PSA test use was lower for Hispanic men (OR=0.79; 95% CI 0.64, 0.97) compared with non-Hispanic white men, and for never-married men (OR=0.74; 95% CI 0.59, 0.92) compared with married men. Frequent PSA test use was higher for both overweight (OR=1.22; 95% CI 1.07, 1.39) and obese (OR=1.21; 95% CI 1.04, 1.41) men compared with underweight men and men with a normal BMI. Men with a family history of prostate cancer had higher odds of frequent PSA testing than men without a family history of prostate cancer in both years; however, the magnitude was greater in 2005 (OR=2.45; 95% CI 1.89, 3.18) ().
Multivariate logistic regression revealed significant interactions with year (2000 vs. 2005, ) for marital status and for number of chronic diseases when we examined the recent-screening outcome. Similarly, we found significant interactions with year for the frequent-testing outcome for number of chronic diseases, family history, and having seen a doctor in the past year. Therefore, all results for year trends are reported based on these categories.
Single, never-married men had a 47% decrease in odds of a recent screening PSA test from 2000 to 2005, while individuals with one chronic disease had a 45% increase in odds of a recent screening PSA test during the same period. Additionally, men with three or more chronic diseases had a 31% increase in odds of recent screening from 2000 to 2005. Trends were different for frequent PSA testing, which declined among individuals with no chronic disease (32% lower odds) and among individuals with two chronic diseases (41% lower odds) from 2000 to 2005. We also saw declines in frequent PSA testing for individuals with no family history of prostate cancer (32% lower odds) and those who had not seen a doctor in the past year (32% lower odds), while individuals with a family history of prostate cancer and those who had seen a doctor in the past year showed no change during the study period.