Duke University School of Medicine, Durham, NC.
Department of Biostatistics and Bioinformatics, Duke University, Durham, NC; Surgery Center for Outcomes Research and Equity in Surgery, Duke University, Durham, NC.
Urology. 2023 Jun;176:237-242. doi: 10.1016/j.urology.2023.03.016. Epub 2023 Mar 25.
To describe the prevalence of PSA screening amongst transgender women. A transgender individual is someone whose gender identity differs from their birth sex or the societal norms of that assigned sex. There are no formal guidelines regarding PSA screening in transgender women, even though they retain prostatic tissue throughout the gender-affirming process, and there is a lack of existing data to adequately inform clinical practice.
We identified a cohort of transgender women in the IBM MarketScan dataset using ICD codes. The patient...s eligibility for inclusion was determined on an annual basis for the years 2013-2019. For each year, we required continuous enrollment, 3 months of post-transgender diagnosis follow-up, and aged 40-80 without a prior diagnosis of prostate malignancy. This cohort was compared to cisgender men with similar eligibility criteria. The proportions of individuals undergoing PSA screening were compared using log-binomial regression.
A group of 2957 transgender women met the inclusion criteria. We saw significantly lower PSA screening rates among transgender individuals for ages 40-54 and 55-69, but higher rates within the age group 70-80 (P.ß<.ß.001 for all).
This is the first study evaluating PSA screening rates for insured transgender women. While the rates for screening in transgender women over the age of 70 are higher, the overall rate of screening for all other age groups lags below the general population in this dataset. Further investigation is necessary to provide equitable care for the transgender community.
描述跨性别女性中 PSA 筛查的流行情况。跨性别者是指其性别认同与其出生时的性别或社会对该性别分配的规范不同的人。尽管跨性别女性在整个性别肯定过程中保留前列腺组织，但目前没有关于 PSA 筛查的正式指南，也缺乏足够的现有数据来为临床实践提供信息。
我们使用 ICD 代码在 IBM MarketScan 数据集中确定了一组跨性别女性。患者的纳入资格每年确定一次，时间为 2013 年至 2019 年。对于每一年，我们要求患者连续参保 3 个月，且在跨性别诊断后进行随访，年龄在 40-80 岁之间，没有前列腺恶性肿瘤的既往诊断。将这一队列与符合类似纳入标准的顺性别男性进行比较。使用对数二项式回归比较进行 PSA 筛查的个体比例。
有 2957 名跨性别女性符合纳入标准。我们发现，40-54 岁和 55-69 岁的跨性别个体 PSA 筛查率显著较低，但 70-80 岁年龄组的筛查率较高（所有 P.ß<.ß.001）。
这是第一项评估有保险的跨性别女性 PSA 筛查率的研究。虽然 70 岁以上跨性别女性的筛查率较高，但在该数据集的所有其他年龄组中，总体筛查率低于一般人群。需要进一步调查，为跨性别群体提供公平的护理。
