Abstract: PD32-05
Sources of Funding: None

Introduction

The Affordable Care Act of 2010 transformed medical insurance and healthcare access for Americans. A significant component of the ACA, was expansion of Medicaid eligibility for low income individuals. Five states (CA, CT, MN, NJ, WA) & DC expanded Medicaid eligibility prior to the ACA mandate. The effect that improved coverage had on the prevalence of prostate specific antigen (PSA) screening is unknown.

Methods

We compared the rate of self-reported PSA as a function of state Medicaid early expansion (MEE) vs. non-expansion (NE). Data from the 2012 and 2014 Behavioral Risk Factor Surveillance System was used to identify asymptomatic men (aged 40-64) without prostate cancer who reported PSA testing in the past 12 months. Age, race, income, education, insurance, marital status, smoking, access to healthcare provider (HCP), and HCP&[prime]s recommendation to have PSA test were extracted. Income categories were stratified by relationship to federal poverty level (FPL): <138% FPL; 138-400% FPL; >400% FPL. Multivariate logistic regression models were used to evaluate the odds of and rate of change in PSA screening among MEE and NE states.

Results

Among 158,103 survey respondents, the prevalence of PSA screening decreased between 2012 and 2014 (OR 0.87, p<0.001), rates were similar in MEE and NE states (OR 1.02, p=0.8). The decrease was smallest in low-income populations <138% FPL than in higher income populations (OR 0.92, p=0.27; OR 0.88, p=0.002; and OR 0.85, p<0.001 respectively). Men <138% FPL were more likely to undergo PSA screening if living in a MEE than NE state (OR 1.6, p=0.04). In this population of men <138% FPL in MEE states, there was an increase in PSA screening (Figure 1), especially if they were Hispanic or Non-Hispanic black (NHB) males (OR 1.53 and 1.62 respectively, both p<0.001). Though access to HCP and insurance status were lowest among those <138% FPL, these variables did not significantly affect the prevalence of PSA screening.

Conclusions

Regardless of income or expansion of access, self-reported PSA screening declined between 2011 and 2013. This may be in part due to the 2012 United States Preventive Services Task Force recommendation against PSA-based screening. However, Medicaid expansion decreased the disparity between PSA baseline screening rates for low-income populations, particularly among Hispanic and NHB males.

Funding

None