Prostate Cancer Screening Disparities in Persons Experiencing Homelessness

Abstract

PURPOSE: The purpose of this study was to assess prostate-specific antigen (PSA) testing rates in persons experiencing homelessness (PEH), identify factors associated with screening, and compare PSA screening rates in PEH with a matched cohort of persons not experiencing homelessness (non-PEH). MATERIALS AND METHODS: We identified 9,249 potentially eligible PEH cared for at a large metropolitan hospital system from an institutional registry of all patients who presented to the health care system as homeless from 2014 to 2021. Homelessness was defined by the presence of the Z-code for homelessness (Z59), the listed address matching to the address of a homeless shelter or other transitional housing or a positive screen for homelessness. A matched cohort of 10,000 non-PEH was generated for comparison. Univariate chi-square analysis and multivariate logistic regression were performed to evaluate variables associated with PSA testing. RESULTS: A total of 1,605 PEH and 3,413 non-PEH were eligible for PSA screening within the study timeframe. Half of PEH were Black (50%). Medicaid was the most common insurance (51%), followed by Medicare (18%). PEH were less likely to have a PCP (58% v 81%, P < .001) and had a significantly lower PSA testing rate (13% v 34%, P < .001) compared with non-PEH. Univariate analysis revealed that PSA testing was more common in PEH who were employed ( P < .001), had private insurance or Medicare ( P < .001), or had an established primary care provider (PCP; P < .001). Multivariate analysis confirmed that having a PCP (OR, 2.54; 95% CI, 1.62 to 4.00; P < .001) significantly increased the likelihood of PSA testing in PEH. CONCLUSION: PEH experience low rates of prostate cancer screening. Interventions to increase screening in this population, including increased PCP access, are needed.

Access to cancer preventive care and program considerations for people experiencing homelessness across four European countries: an exploratory qualitative study

“…Nevertheless, a recent study by Mayo et al. 22 found that having a primary care provider was the most significant factor associated with cancer screening utilisation.…”

Cancer Screening, Treatment, and Outcomes in Persons Experiencing Homelessness: Shifting the Lens to an Understudied Population

“…15,17,20 The rate of cancer screening in the homeless population remains disproportionately low. [20][21][22] In the article that accompanies this editorial, Mayo et al 23 report on their findings from the first nonsurveybased study assessing prostate cancer screening in this population, 24,25 with few other studies assessing colon, breast, and cervical cancer screening. [26][27][28] In this study, the authors highlight the disparities that homeless individuals face and their impact on cancer screening adherence.…”

“…The most significant factor associated with screening is access to a primary care physician, which had not been previously reported. 23 Several barriers are associated with decreased rates of prostate cancer screening including unemployment status and Medicaid insurance. Other studies have identified the following as barriers to cancer screening in this population: lack of an accompanying companion to procedures, 29 fear from prior trauma, [30][31][32] access, 17,20,24,33,34 low health literacy, 35 low rates of health education during clinical encounters.…”

“…The most significant factor associated with screening is access to a primary care physician, which had not been previously reported. 23…”

Editorial Comment

“…For example, a recent JCO Oncology Practice paper found that homeless individuals had higher rates of substance abuse, less access to primary care services, less insurance coverage, and significantly lower rates of PSA screening. 3…”