Pucheril Daniel, Sammon Jesse D, Sood Akshay, Abdollah Firas, Choueiri Toni K, Meyer Christian, Hanske Julian, Kim Simon P, Nguyen Paul L, Kibel Adam S, Weissman Joel S, Menon Mani, Trinh Quoc-Dien
VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI.
Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
Urol Oncol. 2015 Dec;33(12):503.e7-15. doi: 10.1016/j.urolonc.2015.07.019. Epub 2015 Aug 28.
The quality of medical care to US veterans, as provided by the Veterans Health Administration, has recently been subjected to heightened scrutiny. We sought to report prostate-specific antigen screening (PSAS) in a contemporary cohort of veteran men (VM) vs. nonveteran men (NVM). We hypothesize that VM are less likely to receive age-appropriate PSAS compared with NVM.
We identified VM and NVM aged 55 to 69 years without history of prostate cancer who underwent PSA testing in the year preceding that of the 2012 Behavioral Risk Factor and Surveillance System survey. The prevalence of PSAS among VM and NVM was determined in aggregate and on a state-by-state basis. Complex samples logistic regression models calculated the odds of PSAS based on veteran status, adjusted for patient/demographic characteristics.
In all, 56,962 responses were collected, yielding a weighted estimate of 23.7 million men, of which 30.5% were VM. Overall, 45.2% (CI: 43.9%-46.5%) of VM reported PSAS compared with only 37.5% (CI: 36.5%-38.5%) of NVM. VM were more likely to have health insurance (92.0%; CI: 91.3%-92.8% vs. 86.2%; CI: 85.4%-87.0%) and a regular health care provider (89.0%; CI: 88.2%-89.8% vs. 85.9%; CI: 85.1%-86.6%) compared with NVM. Unadjusted prevalence of PSAS varied widely across the United States for VM and NVM. In multivariable analyses, VM had higher odds for PSAS (odds ratio = 1.10, CI: 1.02%-1.18%).
Contrary to our initial hypothesis, our findings suggest a continued pattern of greater preventive health services use by veterans. VM were more likely to undergo PSAS than NVM. This is, in part, attributable to better access to primary care and health insurance. Nonetheless, heterogeneity in screening practices remained largely dependent on geography.
退伍军人健康管理局为美国退伍军人提供的医疗服务质量最近受到了更严格的审查。我们试图报告当代退伍军人男性（VM）与非退伍军人男性（NVM）中前列腺特异性抗原筛查（PSAS）的情况。我们假设与NVM相比，VM接受适龄PSAS的可能性较小。
我们确定了年龄在55至69岁之间、无前列腺癌病史且在2012年行为危险因素和监测系统调查前一年接受过PSA检测的VM和NVM。汇总并按州确定VM和NVM中PSAS的患病率。复杂样本逻辑回归模型根据退伍军人身份计算PSAS的几率，并对患者/人口统计学特征进行调整。
总共收集了56,962份回复，得出加权估计有2370万男性，其中30.5%为VM。总体而言，45.2%（CI：43.9%-46.5%）的VM报告接受了PSAS，而NVM中只有37.5%（CI：36.5%-38.5%）。与NVM相比，VM更有可能拥有医疗保险（92.0%；CI：91.3%-92.8%对86.2%；CI：85.4%-87.0%）和常规医疗服务提供者（89.0%；CI：88.2%-89.8%对85.9%；CI：85.1%-86.6%）。VM和NVM中PSAS的未调整患病率在美国各地差异很大。在多变量分析中，VM进行PSAS的几率更高（优势比=1.10，CI：1.02%-1.18%）。
与我们最初的假设相反，我们的研究结果表明退伍军人使用预防性医疗服务的模式持续增加。VM比NVM更有可能接受PSAS。这部分归因于更容易获得初级保健和医疗保险。尽管如此，筛查做法的异质性在很大程度上仍取决于地理位置。
