title: Contemporary nationwide patterns of self-reported prostate-specific antigen screening in US veterans.
abstract: OBJECTIVE
  The quality of medical care to US veterans, as provided by the Veterans Health Administration, has recently been subjected to heightened scrutiny. We sought to report prostate-specific antigen screening (PSAS) in a contemporary cohort of veteran men (VM) vs. nonveteran men (NVM). We hypothesize that VM are less likely to receive age-appropriate PSAS compared with NVM.
  
  
  METHODS
  We identified VM and NVM aged 55 to 69 years without history of prostate cancer who underwent PSA testing in the year preceding that of the 2012 Behavioral Risk Factor and Surveillance System survey. The prevalence of PSAS among VM and NVM was determined in aggregate and on a state-by-state basis. Complex samples logistic regression models calculated the odds of PSAS based on veteran status, adjusted for patient/demographic characteristics.
  
  
  RESULTS
  In all, 56,962 responses were collected, yielding a weighted estimate of 23.7 million men, of which 30.5% were VM. Overall, 45.2% (CI: 43.9%-46.5%) of VM reported PSAS compared with only 37.5% (CI: 36.5%-38.5%) of NVM. VM were more likely to have health insurance (92.0%; CI: 91.3%-92.8% vs. 86.2%; CI: 85.4%-87.0%) and a regular health care provider (89.0%; CI: 88.2%-89.8% vs. 85.9%; CI: 85.1%-86.6%) compared with NVM. Unadjusted prevalence of PSAS varied widely across the United States for VM and NVM. In multivariable analyses, VM had higher odds for PSAS (odds ratio = 1.10, CI: 1.02%-1.18%).
  
  
  CONCLUSIONS
  Contrary to our initial hypothesis, our findings suggest a continued pattern of greater preventive health services use by veterans. VM were more likely to undergo PSAS than NVM. This is, in part, attributable to better access to primary care and health insurance. Nonetheless, heterogeneity in screening practices remained largely dependent on geography.
authors: VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI.
authors: Daniel
authors: D
authors: Pucheril
authors: VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI.
authors: Jesse D
authors: JD
authors: Sammon
authors: VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI.
authors: Akshay
authors: A
authors: Sood
authors: VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI.
authors: Firas
authors: F
authors: Abdollah
authors: Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors: Toni K
authors: TK
authors: Choueiri
authors: Division of Urologic Oncology and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors: Christian
authors: C
authors: Meyer
authors: Division of Urologic Oncology and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors: Julian
authors: J
authors: Hanske
authors: Department of Urology and Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, CT.
authors: Simon P
authors: SP
authors: Kim
authors: Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors: Paul L
authors: PL
authors: Nguyen
authors: Division of Urologic Oncology and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors: Adam S
authors: AS
authors: Kibel
authors: Center for Surgery and Public Health, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
authors: Joel S
authors: JS
authors: Weissman
authors: VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI.
authors: Mani
authors: M
authors: Menon
authors: VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI; Division of Urologic Oncology and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA. Electronic address: trinh.qd@gmail.com.
authors: Quoc-Dien
authors: QD
authors: Trinh
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000378:metabolism*; D012307:Risk Factors; D057566:Self Report; D014481:United States; D014728:Veterans
chemical_list: D017430:Prostate-Specific Antigen
keywords: Prostate-specific antigen; Screening; Veterans