Patterns of prostate-specific antigen testing by remoteness of residence and socio-economic status: An Australian population-based study

Abstract

Objective: Describes the variation in prostate cancer testing by the remoteness of residence and socio‐economic status groups in Australia.

Design: A national population‐based descriptive study using Medicare data extracted by the Department of Health (formerly the Department of Health and Ageing).

Setting: Australia.

Participants: All men, with a Medicare‐reimbursed prostate‐specific antigen test conducted in Australia between 2002 and 2017, were included. We focused on “screening and case finding” tests (Medicare Benefits Schedule item number 66655) from 1 April 2005 to 31 December 2009, to describe testing differences in subgroups. Groups were categorised into State and Territory, socio‐economic status and region of residence. A negative binomial regression model was fitted to measure the incidence rate ratios of those who had a screening prostate‐specific antigen test by group.

Main outcome measures: Age‐standardised testing rates and incidence rate ratios.

Results: Between 2002 and 2017, 11 588 775 screening prostate‐specific antigen tests were reimbursed by the Department of Human Services. During 2005‐2009, 52% of all Australian men, aged 40 years and over, had a screening test. The incidence rate ratios differed by State and Territory. Men aged 40 years and over, living in very remote areas, were 43% less likely to have had a screening test than residents of major cities. Prostate‐specific antigen testing rates fell in all age groups between 2007 and 2009 and 2017.

Conclusions: The prostate‐specific antigen testing behaviour differs between community groups in Australia. Men were less likely to have had a screening prostate‐specific antigen test the farther they lived from the major cities. This highlights the need for a more targeted approach to achieve an equitable and evidence‐based prostate cancer care across all sectors of the community.