Purpose: :To determine the geographic variability (by states) in receiving the prostate cancer (PC) screening in the United States (US), after adjusting for the individual level factors using the multilevel modeling technique.
Method: Behavioral Risk Factor Surveillance System (BRFSS) 2010 dataset was used. Study population consisted of men aged 50 years of more whose responses were recorded as either yes or no when asked about having a prostate specific antigen test or digital rectal examination during the last one year. To test the geographical variability individuals were assigned to one of the 50 states of the US, the District of Columbia or the three territories of Puerto Rico, the US Virgin Islands and Guam. The following level-1 variables were included in the final model: Age, education level, employment status, marital status, income, race/ethnicity, self-reported health status, obesity status, alcohol consumption, smoking status presence of a personal physician, and health insurance coverage. Level-2 variables include number of doctors/100,000 persons in each state, United States regions and Metropolitan Status Area (MSA) codes status. Two-level (multilevel) logistic regression models were used with receiving PC screening in last one year as the dependent variable (yes or no).
Result: : Significant geographical variability exist in receiving PC screening even after adjusting for the socioeconomic status.
Conclusion: People living in rural area have higher probability of receiving the prostate cancer screening. Higher socio-economic status is predictor of receiving prostate cancer screening. African-American men have lower odds (0.8, CI=0.7-0.9) of receiving prostate cancer screening. Smoking, heavy drinking, and being obese are independently associated with lower probabilities of receiving prostate cancer screening.
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