Abstract
Purpose
To evaluate how limited English proficiency (LEP) impacts the prevalence of prostate-specific antigen (PSA) screening in a contemporary, nationally representative cohort of men in the USA.
Methods
The Medical Expenditure Panel Survey was utilized to identify the prevalence of PSA screening between 2013 and 2016 among men ≥ 55. Men who speak a language other than English at home were stratified by self-reported levels of English proficiency (men who speak English very well, well, not well, or not at all). Survey weights were applied, and groups were compared using the adjusted Wald test. A multivariable logistic regression model was used to identify predictors of PSA screening adjusting for patient-level covariates.
Results
The cohort included 2,889 men, corresponding to a weighted estimate of 4,765,682 men. 79.6% of men who speak English very well reported receiving at least one lifetime PSA test versus 58.4% of men who do not speak English at all (p < 0.001). Men who reported not speaking English at all had significantly lower prevalence of PSA screening (aOR 0.56; 95% CI 0.35–0.91; p = 0.019). Other significant predictors of PSA screening included older age, income > 400% of the federal poverty level, insurance coverage, and healthcare utilization.
Conclusions
Limited English proficiency is associated with significantly lower prevalence of PSA screening among men in the USA. Interventions to mitigate disparities in prostate cancer outcomes should account for limited English proficiency among the barriers to guideline-concordant care.
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Data availability
The data underlying this article are available on request to the senior author. The datasets were derived from sources in the public domain (The Medical Expenditure Panel Survey, https://meps.ahrq.gov).
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by BS, ML, DF, EB, and SL. The first draft of the manuscript was written by BS, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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ASF reports consulting fees from Janssen, Olympus, Urogen, Lantheus, stock options from Vessi Medical and Scentient, and research funding from Convergent Genomics and NIH. ASK reports consulting fees from Profound, Janssen, Merck, Bayer, Cellvax, Candel, Bristle-Meyer Squibb. QDT reports consulting fees from Astellas, Bayer, and Janssen outside the submitted work and research funding from the American Cancer Society and Pfizer Global Medical Grants. APC reports research funding from the American Cancer Society and Pfizer Global Medical Grants. The other co-authors report no conflicts of interest.
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Stone, B.V., Labban, M., Beatrici, E. et al. The effect of limited english proficiency on prostate-specific antigen screening in American men. World J Urol 42, 54 (2024). https://doi.org/10.1007/s00345-023-04725-0
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DOI: https://doi.org/10.1007/s00345-023-04725-0