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.
BMC Urol. 2022 Jun 25;22(1):91. doi: 10.1186/s12894-022-01045-0.
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.
为了探究美国预防服务工作组（USPSTF）2012 年反对基于前列腺特异性抗原（PSA）的前列腺癌筛查建议对保险状况导致的生存差异的影响。在 USPSTF 2012 年的筛查建议之前，先前的研究发现，患有前列腺癌的参保患者的预后比未参保患者好。
我们使用 SEER 18 数据库，根据诊断时间和保险状况检查前列腺癌特异性生存（PCSS）。如果患者在 2010-2012 年被诊断为属于 USPSTF 前时代，如果在 2014-2016 年被诊断为属于 USPSTF 后时代。采用 Kaplan-Meier 方法测量 PCSS，采用 Cox 比例风险模型测量差异。
在 USPSTF 前时代，未参保患者的 PCSS 比参保患者差（调整后的 HR 1.256，95%CI 1.037-1.520，p=0.020）。由于参保患者的 PCSS 下降，而未参保患者的 PCSS 不变，因此，在 USPSTF 后时代，这种生存差异不再存在（调整后的 HR 0.946，95%CI 0.642-1.394，p=0.780）。
尽管原因尚不清楚，但 USPSTF 2012 年 PSA 筛查建议可能阻碍了参保患者定期接受前列腺癌筛查，并选择性地导致参保患者的预后恶化，而未影响未参保患者的生存。
