PDF(Pubmed)
Abstract：
Prostate cancer screening using prostate-specific antigen (PSA) testing is controversial but remains prevalent in many countries. There is little information in Sweden or elsewhere on the spatial variation in PSA testing. This study aims to describe the spatio-temporal variation in PSA testing prior to a prostate cancer diagnosis in the Stockholm region at the municipality and small area levels. A population-based register study comprised men aged 40 years and over living in the Stockholm region during 2007-2016. For Stockholm in 2016, we reported the proportion of men who had a PSA test for the preceding one, two, five and ten years by ten-year age groups. The age-standardised proportion of men having a PSA test was reported for municipalities by calendar years. We used spatial smoothing for calculating the age-standardised proportion of men having a PSA test in a small area for each calendar year. In 2016, 74.0% and 77.8% of men aged 60-69 and 70-79 years respectively had taken a PSA test in the previous ten years. The municipalities of Danderyd and Ekerö showed high proportions of PSA testing. A marked heterogeneity in such proportions within each municipality was observed. The odds ratio for having a PSA test for those born in Sweden was 2.22 (95% CI 2.00-2.52). Opportunistic PSA testing is widespread with three quarters of men in their sixties and seventies having had a test in the preceding decade. We found evidence for marked geographical heterogeneity, where more affluent and metropolitan areas had higher levels of testing. Variations in PSA testing was associated with socio-economic position and demographic factors including education, income and country of birth.
摘要：
使用前列腺特异性抗原（PSA）检测的前列腺癌筛查存在争议，但在许多国家仍然很普遍。在瑞典或其他地方，关于PSA测试的空间变化的信息很少。这项研究旨在描述斯德哥尔摩地区在市政和小区域诊断前列腺癌之前PSA测试的时空变化。一项基于人群的登记研究包括2007-2016年期间居住在斯德哥尔摩地区的40岁及以上的男性。在2016年的斯德哥尔摩，我们报告了进行PSA测试的男性比例，两个,五年和十年的十年年龄组。按日历年，市政当局报告了接受PSA测试的男性的年龄标准化比例。我们使用空间平滑来计算每个日历年在小范围内进行PSA测试的男性的年龄标准化比例。2016年，60-69岁和70-79岁的男性中分别有74.0%和77.8%在过去十年中进行了PSA测试。Danderyd和Ekerö的市政当局对PSA测试的比例很高。在每个城市中观察到这种比例的明显异质性。在瑞典出生的人进行PSA测试的比值比为2.22（95％CI2.00-2.52）。机会性PSA测试很普遍，在过去的十年中，六七十岁的男性中有四分之三进行了测试。我们发现了明显的地理异质性的证据，较富裕和大都市地区的检测水平较高。PSA测试的变化与社会经济地位和人口因素有关，包括教育，收入和出生国。
