Reconstructing PSA testing patterns between black and white men in the US from Medicare claims and the National Health Interview Survey

BACKGROUND: Frequencies of prostate-specific antigen (PSA) test administration were not actively monitored on a national level during the first decade of PSA testing. The objectives of this article were to reconstruct patterns of PSA testing between black and white men in the US and to determine the extent of any racial disparity in PSA use. METHODS: Data from the 2000 National Health Interview Survey were used to model the adoption of PSA and to estimate the distribution of age at first test. Longitudinal Medicare claims data were used to estimate the distribution of intervals between tests. The rates of initial and subsequent tests were then combined by simulation to reconstruct individual screening histories. Results are from the reconstructed model. RESULTS: Overall, 45% of white men and 43% of black men within ages 40-84 years had at least 1 PSA test by the year 2000. The authors found that among older men, whites adopted PSA screening earlier than blacks, whereas among younger men, this trend was reversed, with blacks adopting screening earlier than whites. Annual testing frequencies generated by the simulation model were higher for white men aged>or=60 years and higher for black men aged<60 years. CONCLUSIONS: Findings indicated fairly similar patterns overall of PSA testing for blacks and whites. These similarities indicated that racial disparity in PSA testing is probably not a major factor behind current racial differences in prostate cancer mortality rates and declines. Knowledge of patterns of screening is important to an understanding of the impact of population screening on cancer incidence and mortality, but retrospective data sources have significant limitations when used to estimate these patterns of care.