Introduction:

Disabled patients who are a unique minority population, may have lower literacy levels and have difficulty communicating with physicians. The effect of these on their knowledge of cancer prevention recommendations is unknown. Herein, we aim to examine the predictors of prostate-specific antigen (PSA) testing and prostate cancer (PCa) detection rates among the disabled population in comparison to the non-disabled population in the USA. 

Methods:

Utilizing the USA Health Information National Trends Survey (HINTS), 4^th and 5^th Edition, a cross-sectional study from 2012 was carried out to analyze factors predicting PSA testing and PCa detection rates in men with disabilities (disabled, deaf, blind). Associations between each covariate and PSA testing and PCa detection were determined, and multivariable logistic regression models were used to determine clinically significant predictors of PSA testing and PCa detection in men with disabilities compared to that of the healthy cohort. 

Results:

A total of 798 (21.6%) disabled men were compared to 2,893 (78.4%) non-disabled men.  Disabled men were older with a mean age of 65.1±14 years vs. 54.5±16, p<0.001. On univariable analysis, disabled men had significantly higher PSA screening rates (64.1% vs. 51.6%, p<0.001) (Figure 1), although PCa detection rates were not statistically different (34.9% vs. 28.2%, p=0.113). On multivariable analysis, after adjusting for all available confounders including race, age, socioeconomic status, geographical region, survey year, marital status, and others, men with disabilities were less likely to undergo PSA screening (OR 0.71, 95% CI 0.547-0.921, p=0.010), and more likely to be diagnosed with PCa (OR 1.80, 95% CI 1.034-3.138, p=0.038) (Table 1). Other variables associated with increased PSA screening included having a healthcare provider, health insurance, and living with a partner. Covariates associated with increased PCa detection included older age and African American ethnicity. 

Conclusion:

Significant inequalities in PSA screening exist among men with disabilities in the USA. Our data shows that men with disabilities were less likely to be offered PSA screening but were at a higher risk of being diagnosed with PCa. These findings suggest a need to implement strategies to reduce existing gaps in the care of disabled men, as well as identify the etiology causing a potential higher risk for PCa incidence in disabled men.  

Funding: N/A