Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Sociology and Social Work, Aalborg University, Aalborg Øst, Denmark.
PLoS One. 2024 Aug 15;19(8):e0308254. doi: 10.1371/journal.pone.0308254. eCollection 2024.
Prostate cancer screening using prostate-specific antigen (PSA) testing is controversial but remains prevalent in many countries. There is little information in Sweden or elsewhere on the spatial variation in PSA testing. This study aims to describe the spatio-temporal variation in PSA testing prior to a prostate cancer diagnosis in the Stockholm region at the municipality and small area levels. A population-based register study comprised men aged 40 years and over living in the Stockholm region during 2007-2016. For Stockholm in 2016, we reported the proportion of men who had a PSA test for the preceding one, two, five and ten years by ten-year age groups. The age-standardised proportion of men having a PSA test was reported for municipalities by calendar years. We used spatial smoothing for calculating the age-standardised proportion of men having a PSA test in a small area for each calendar year. In 2016, 74.0% and 77.8% of men aged 60-69 and 70-79 years respectively had taken a PSA test in the previous ten years. The municipalities of Danderyd and Ekerö showed high proportions of PSA testing. A marked heterogeneity in such proportions within each municipality was observed. The odds ratio for having a PSA test for those born in Sweden was 2.22 (95% CI 2.00-2.52). Opportunistic PSA testing is widespread with three quarters of men in their sixties and seventies having had a test in the preceding decade. We found evidence for marked geographical heterogeneity, where more affluent and metropolitan areas had higher levels of testing. Variations in PSA testing was associated with socio-economic position and demographic factors including education, income and country of birth.
使用前列腺特异性抗原（PSA）检测进行前列腺癌筛查存在争议，但在许多国家仍然普遍存在。瑞典或其他地方关于 PSA 检测的空间变化的信息很少。本研究旨在描述斯德哥尔摩地区在前列腺癌诊断前 PSA 检测的时空变化，在市和小区域两级进行。一项基于人群的登记研究包括 2007-2016 年间居住在斯德哥尔摩地区的 40 岁及以上的男性。对于 2016 年的斯德哥尔摩，我们报告了前一年、两年、五年和十年中每十年年龄组接受 PSA 检测的男性比例。按历年报告了各市的 PSA 检测男性的年龄标准化比例。我们使用空间平滑来计算每个历年小区域内接受 PSA 检测的男性的年龄标准化比例。2016 年，分别有 74.0%和 77.8%的 60-69 岁和 70-79 岁男性在前十年接受过 PSA 检测。Danderyd 和 Ekerö 这两个市的 PSA 检测比例较高。在每个市中，这种比例都存在明显的异质性。出生在瑞典的男性接受 PSA 检测的比值比为 2.22（95%CI 2.00-2.52）。机会性 PSA 检测很普遍，四分之三的六七十岁男性在前十年接受过检测。我们发现存在明显的地理异质性，较富裕和大都市区的检测水平较高。PSA 检测的变化与社会经济地位和人口因素有关，包括教育、收入和出生国。
