澳大利亚不同地理区域和社会经济地位下前列腺特异性抗原（PSA）“筛查”模式的变化：对 50-69 岁男性医疗保险数据的分析。
Changes in prostate specific antigen (PSA) "screening" patterns by geographic region and socio-economic status in Australia: Analysis of medicare data in 50-69 year old men.
机构信息
The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia; Sydney School of Public Health, The University of Sydney, Australia.
School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; Australian Centre for Health Services Innovation & Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia; Centre for Data Science, Queensland University of Technology, Brisbane, Australia.
出版信息
Cancer Epidemiol. 2023 Apr;83:102338. doi: 10.1016/j.canep.2023.102338. Epub 2023 Feb 24.
BACKGROUND
While it is known that national PSA testing rates have decreased in Australia since 2007, it is not known whether these trends are consistent by broad geographical areas, nor whether previously reported area-specific differences have remained in more recent time periods.
METHODS
Population-based cohort study of Australian men (n = 2793,882) aged 50-69 who received at least one PSA test (Medicare Benefit Schedule item number 66655) during 2002-2018. Outcome measures included age-standardised participation rate, annual percentage change using JoinPoint regression and indirectly standardised participation rate ratio using multivariable Poisson regression.
RESULTS
During 2005-09, two thirds (68%) of Australian men aged 50-69 had at least one PSA test, reducing to about half (48%) during 2014-18. In both periods, testing rates were highest among men living in major cities, men aged 50-59 years, and among men living in the most advantaged areas. Nationally, the Australian PSA testing rate increased by 9.2% per year between 2002 and 2007, but then decreased by 5.0% per year to 2018. This pattern was generally consistent across States and Territories, and socio-economic areas, however the magnitude of the trends was less pronounced in remote and very remote areas.
CONCLUSIONS
The decreasing trends are consistent with a greater awareness of the current guidelines for clinical practice in Australia, which recommend a PSA test be done only with the informed consent of individual men who understand the potential benefits and risks. However, given there remain substantial geographical disparities in prostate cancer incidence and survival in Australia, along with the equivocal evidence for any benefit from PSA screening, there remains a need for more effective diagnostic strategies for prostate cancer to be implemented consistently regardless of where men live.
背景
自 2007 年以来，澳大利亚全国范围内的 PSA 检测率有所下降，但是否存在按广泛地理区域划分的一致趋势，以及先前报告的特定区域差异是否在最近的时期内仍然存在，尚不清楚。
方法
这是一项基于人群的队列研究，纳入了澳大利亚 50-69 岁男性（n=2793882），他们在 2002-2018 年期间至少接受过一次 PSA 检测（医疗保险福利表项目编号 66655）。结局指标包括年龄标准化参与率、使用 JoinPoint 回归计算的年度百分比变化和使用多变量泊松回归计算的间接标准化参与率比。
结果
在 2005-09 年期间，三分之二（68%）的 50-69 岁澳大利亚男性至少接受过一次 PSA 检测，而在 2014-18 年期间，这一比例下降到约一半（48%）。在这两个时期，检测率在主要城市居住的男性、50-59 岁的男性以及在最具优势地区居住的男性中最高。在全国范围内，澳大利亚的 PSA 检测率在 2002 年至 2007 年期间每年增加 9.2%，但随后每年减少 5.0%，至 2018 年。这种模式在各州和地区以及社会经济区域中基本一致，但是在偏远和极偏远地区，这种趋势的幅度较小。
结论
这种下降趋势与澳大利亚对临床实践现行指南的认识提高一致，这些指南建议只有在个体男性知情同意的情况下，在其了解潜在获益和风险的情况下，才进行 PSA 检测。然而，鉴于澳大利亚前列腺癌的发病率和生存率仍存在较大的地域差异，以及 PSA 筛查的获益存在争议，因此仍需要实施更有效的前列腺癌诊断策略，而不论男性居住在哪里。
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