Kohar A, Cramb S M, Pickles K, Smith D P, Baade P D
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.
Centre for Data Science, Faculty of Science, QUT, Brisbane, 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.
Public Health. 2023 Apr;217:173-180. doi: 10.1016/j.puhe.2023.01.039. Epub 2023 Mar 8.
In Australia, while prostate-specific antigen (PSA) testing rates vary by broad area-based categories of remoteness and socio-economic status, little is known about the extent of variation within them. This study aims to describe the small-area variation in PSA testing across Australia.
This was a retrospective population-based cohort study.
We received data for PSA testing from the Australian Medicare Benefits Schedule. The cohort included men (n = 925,079) aged 50-79 years who had at least one PSA test during 2017-2018. A probability-based concordance was applied across multiple iterations (n = 50) to map each postcode to small areas (Statistical Areas 2; n = 2,129). For each iteration, a Bayesian spatial Leroux model was used to generate smoothed indirectly standardized incidence ratios across each small area, with estimates combined using model averaging.
About a quarter (26%) of the male population aged 50-79 years had a PSA test during 2017-2018. Testing rates among small areas varied 20-fold. Rates were higher (exceedance probability>0.8) compared with the Australian average in the majority of small areas in southern Victoria and South Australia, south-west Queensland, and some coastal regions of Western Australia but lower (exceedance probability<0.2) in Tasmania and Northern Territory.
The substantial geographical variation in PSA testing rates across small areas of Australia may be influenced by differences in access to and guidance provided by clinicians and attitudes and preferences of men. Greater understanding of PSA testing patterns by subregions and how these patterns relate to health outcomes could inform evidence-based approaches to identifying and managing prostate cancer risk.
在澳大利亚，虽然前列腺特异性抗原（PSA）检测率因基于广泛区域的偏远程度和社会经济地位类别而有所不同，但对于这些类别内部的差异程度却知之甚少。本研究旨在描述澳大利亚各地PSA检测的小区域差异。
这是一项基于人群的回顾性队列研究。
我们从澳大利亚医疗保险福利计划中获取了PSA检测数据。该队列包括年龄在50 - 79岁之间、在2017 - 2018年期间至少进行过一次PSA检测的男性（n = 925,079）。通过多次迭代（n = 50）应用基于概率的一致性方法，将每个邮政编码映射到小区域（统计区域2；n = 2,129）。对于每次迭代，使用贝叶斯空间勒鲁模型在每个小区域生成平滑的间接标准化发病率比，并通过模型平均合并估计值。
在2017 - 2018年期间，约四分之一（26%）的50 - 79岁男性进行了PSA检测。小区域之间的检测率相差20倍。在维多利亚州南部和南澳大利亚州的大多数小区域、昆士兰州西南部以及西澳大利亚州的一些沿海地区，检测率高于澳大利亚平均水平（超标概率>0.8），但在塔斯马尼亚州和北领地则较低（超标概率<0.2）。
澳大利亚小区域之间PSA检测率的显著地理差异可能受到临床医生提供的检测机会和指导以及男性态度和偏好差异的影响。对次区域PSA检测模式以及这些模式与健康结果之间关系的更深入了解，可为识别和管理前列腺癌风险的循证方法提供依据。
