Association between PSA testing and age, ethnicity, social deprivation, BMI and comorbidity
| Cofactor | Description | PSA study group (N=150 481) | ||
|---|---|---|---|---|
| Unadjusted OR (95% CI) | Age-adjusted OR (95% CI)* | Age-adjusted and covariate-adjusted OR (95% CI)† | ||
| Prostate cancer risk factors | ||||
| Age | 40–44 years (n=37 668) | 1.00 (Reference) | NA | 1.00 (Reference) |
| 45–49 years (n=30 792) | 2.04 (1.92 to 2.17) | NA | 2.00 (1.88 to 2.12) | |
| 50–54 years (n=24 982) | 3.66 (3.45 to 3.87) | NA | 3.44 (3.25 to 3.65) | |
| 55–59 years (n=18 658) | 5.47 (5.17 to 5.79) | NA | 4.81 (4.54 to 5.10) | |
| 60–64 years (n=12 814) | 7.37 (6.94 to 7.82) | NA | 5.91 (5.56 to 6.29) | |
| 65–69 years (n=8839) | 9.21 (8.64 to 9.81) | NA | 6.71 (6.28 to 7.17) | |
| 70–74 years (n=6105) | 11.31 (10.55 to 12.11) | NA | 7.34 (6.82 to 7.90) | |
| 75–79 years (n=5152) | 12.14 (11.29 to 13.05) | NA | 6.86 (6.35 to 7.42) | |
| 80–84 years (n=3320) | 11.64 (10.71 to 12.65) | NA | 6.02 (5.49 to 6.60) | |
| 85–89 years (n=1527) | 11.24 (10.04 to 12.59) | NA | 5.41 (4.77 to 6.14) | |
| 90–94 years (n=522) | 9.63 (7.99 to 11.61) | NA | 4.35 (3.54 to 5.35) | |
| ≥95 years (n=102) | 6.98 (4.51 to 10.81) | NA | 3.25 (2.02 to 5.24) | |
| Ethnicity | White (n=61 621) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
| Black (n=25 956) | 1.47 (1.41 to 1.52) | 1.74 (1.68 to 1.81) | 1.78 (1.71 to 1.85) | |
| South Asian‡ (n=39 341) | 0.94 (0.91 to 0.97) | 1.13 (1.09 to 1.17) | 1.08 (1.04 to 1.12) | |
| Chinese (n=1363) | 0.65 (0.55 to 0.76) | 0.66 (0.56 to 0.78) | 0.67 (0.56 to 0.80) | |
| Mixed black (n=2299) | 1.88 (1.71 to 2.06) | 2.23 (2.02 to 2.46) | 2.25 (2.03 to 2.50) | |
| Mixed Asian‡ (n=235) | 0.97 (0.69 to 1.37) | 1.23 (0.86 to 1.76) | 1.21 (0.83 to 1.76) | |
| Other mixed (n=608) | 0.65 (0.51 to 0.83) | 1.03 (0.80 to 1.32) | 1.00 (0.77 to 1.30) | |
| Other ethnicity (n=5909) | 1.03 (0.96 to 1.10) | 1.19 (1.11 to 1.29) | 1.10 (1.02 to 1.19) | |
| Not defined (n=13 149) | 0.44 (0.41 to 0.48) | 0.57 (0.53 to 0.61) | 0.60 (0.56 to 0.65) | |
| BMI§ | Normal weight (n=47 619) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
| Underweight (n=1558) | 0.96 (0.84 to 1.11) | 0.79 (0.68 to 0.92) | 0.82 (0.70 to 0.95) | |
| Overweight (n=58 787) | 1.26 (1.22 to 1.30) | 1.19 (1.15 to 1.23) | 1.18 (1.14 to 1.22) | |
| Obese class I (n=22 985) | 1.49 (1.43 to 1.55) | 1.31 (1.26 to 1.37) | 1.29 (1.24 to 1.35) | |
| Obese class II (n=6026) | 1.58 (1.48 to 1.69) | 1.34 (1.26 to 1.44) | 1.31 (1.22 to 1.41) | |
| Obese class III (n=2044) | 1.55 (1.39 to 1.73) | 1.36 (1.22 to 1.52) | 1.38 (1.23 to 1.55) | |
| Non-risk factors | ||||
| Deprivation quintiles**,¶ | Least deprived (n=32 780) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
| Q2 (n=25 022) | 0.95 (0.91 to 1.00 | 0.97 (0.92 to 1.01) | 0.96 (0.92 to 1.01) | |
| Q3 (n=25 802) | 0.93 (0.89 to 0.97) | 0.95 (0.90 to 0.99) | 0.94 (0.90 to 0.99) | |
| Q4 (n=28 637) | 0.92 (0.88 to 0.95) | 0.90 (0.86 to 0.94) | 0.89 (0.85 to 0.93) | |
| Most deprived (n=37 968) | 0.85 (0.82 to 0.89) | 0.85 (0.82 to 0.89) | 0.83 (0.80 to 0.87) | |
| Comorbidity†† | Cardiovascular cluster (n=53 120) | 2.92 (2.87 to 3.03) | 1.60 (1.55 to 1.65) | 1.51 (1.46 to 1.56) |
| HTN (n=38 399) | 2.83 (2.75 to 2.91) | 1.53 (1.50 to 1.60) | 1.49 (1.44 to 1.54) | |
| CVD‡‡ (n=13 635) | 2.50 (2.40 to 2.60) | 1.19 (1.14 to 1.24) | 1.07 (1.02 to 1.12) | |
| DM (n=23 421) | 1.97 (1.90 to 2.03) | 1.22 (1.18 to 1.27) | 1.16 (1.12 to 1.21) | |
| CKD stage 3–5 (n=6098) | 2.76 (2.61 to 2.91) | 1.23 (1.16 to 1.31) | 1.14 (1.06 to 1.21) | |
| Stroke (n=3583) | 2.20 (2.05 to 2.36) | 1.03 (0.96 to 1.11) | 0.98 (0.90 to 1.06) | |
| Respiratory cluster (n=16 616) | 1.55 (1.28 to 1.40) | 1.18 (1.13 to 1.22) | 1.08 (1.03 to 1.13) | |
| Asthma (n=12 792) | 1.34 (1.28 to 1.40) | 1.25 (1.19 to 1.31) | 1.15 (1.10 to 1.21) | |
| COPD (n=5206) | 2.27 (2.14 to 2.41) | 1.06 (1.00 to 1.13) | 0.95 (0.89 to 1.02) | |
| Mental health cluster (n=4572) | 1.18 (1.09 to 1.27) | 0.94 (0.87 to 1.02) | 0.91 (0.84 to 0.99) | |
| Dementia (n=920) | 2.52 (2.20 to 2.89) | 0.92 (0.80 to 1.05) | 0.82 (0.70 to 0.96) | |
| SMI (n=3699) | 0.92 (0.84 to 1.00) | 0.95 (0.86 to 1.04) | 0.95 (0.86 to 1.04) | |
| Other cancer§§ (n=2719) | 2.06 (1.90 to 2.24) | 1.13 (1.03 to 1.23) | 1.02 (0.93 to 1.12) | |
Bold typeface indicates significance at p<0.05.
*Age adjusted in age groups 40–44, 45–49, 50–54, 55–59, 60–64, 65–69, 70–74, 75–79, 80–84, 85–89, 90–94 and ≥95.
†Adjusted for age, BPH, prostatitis, tamsulosin or finasteride use.
‡Indian, Pakistani Bangladeshi or other Asian.
§11 462 BMI values missing.
¶272 Townsend scores missing.
**Quintiles based on Townsend Scores −5 to +10.
††Absence of comorbidity (individual or cluster) acts as reference group.
‡‡Includes IHD, PAD, AF and HF.
§§Excludes benign or malignant prostate cancer.
AF, atrial fibrillation; BPH, benign prostate hypertrophy; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease; DM, diabetes mellitus; HF, heart failure; HTN, hypertension; IHD, ischaemic heart disease; PSA, prostate-specific antigen; SMI, significant mental illness.