American Indian/Alaska Native men are less likely to receive prostate-specific antigen testing and digital rectal exams from primary care providers than White men: a secondary analysis of the National Ambulatory Medical Care Survey from 2012–2018

Abstract

Purpose: (1) Identify the proportion of primary care visits in which American Indian/Alaska Native (AI/AN) men receive a prostate-specific antigen test (PSAT)and/or a digital rectal exam (DRE), (2) describe characteristics of primary care visits in which AI/AN receive PSA and/or DRE, and (3) identify whether AI/AN receive PSA and/or DRE less often than non-Hispanic White (nHW) men. Methods: This was a secondary analysis of the National Ambulatory Medical Care Survey (NAMCS) during 2013–2016 and 2018 and the NAMCS Community Health Center (CHC) datasets from 2012–2015. Weighted bivariate and multivariable tests analyzed the data to account for the complex survey design. Results: For AI/AN men, 1.67 per 100 visits (95% CI = 0–4.24) included a PSATs (or PSAT) and 0 visits included a DRE between 2013–2016 and 2018. The rate of PSA for non-AI/AN men was 9.35 per 100 visits (95% CI = 7.78–10.91) and 2.52 per 100 visits (95% CI = 1.61–3.42) for DRE. AI/AN men were significantly less likely to receive a PSA than nHW men (aOR = 0.09, 95% CI = 0.01–0.83). In CHCs, AI/AN men experienced 4.26 PSAT per 100 visits (95% CI = 0.96–7.57) compared to 5.00 PSAT per 100 visits (95% CI = 4.40–5.68) for non-AI/AN men. DRE rates for AI/AN men was 0.63 per 100 visits (95% CI = 0–1.61) compared to 1.05 per 100 (95% CI = 0.74–1.37) for non-AI/AN men. There was not a statistically significant disparity in the CHC data regarding PSA (OR = 0.91, 95% CI = 0.42–1.98) or DRE (OR = 0.75, 95% CI = 0.15–3.74), compared to nHW men. Conclusion: Efforts are needed to better understand why providers may not use PSA and DRE with AI/AN men compared to nHW men.