Background
Methods
Setting
Study population
Outcome variable
Covariates
Healthcare utilisation
Statistical analysis
Results
Study population characteristics
Population characteristics | PSA tested | ||||
---|---|---|---|---|---|
Ever | Never | ||||
N = 2,473 (68.2%) | N = 1,153 (31.8%) | p-value | |||
Socio-demographic characteristics
| |||||
Age at interview | Years | Median, (IQR) | 64 (57, 71) | 59 (54, 69) | <0.001 |
Marital status | Married | N (%) | 1,916 (77.4) | 795 (69.0) | <0.001 |
Single | N (%) | 248 (10.0) | 178 (15.4) | ||
Sep/Divorced | N (%) | 112 (4.5) | 89 (7.7) | ||
Widowed | N (%) | 199 (8.0) | 91 (7.9) | ||
Education | Primary | N (%) | 771 (31.2) | 425 (36.9) | <0.001 |
Secondary | N (%) | 952 (38.5) | 463 (40.2) | ||
Third Level | N (%) | 752 (30.4) | 265 (23.0) | ||
Employment | Employed | N (%) | 1,007 (40.7) | 508 (44.1) | <0.001 |
Retired | N (%) | 1,225 (49.5) | 406 (35.2) | ||
Other | N (%) | 243 (9.8) | 239 (20.7) | ||
Smoking status | Never | N (%) | 919 (37.2) | 374 (32.4) | <0.001 |
Past | N (%) | 1,215 (49.1) | 471 (40.8) | ||
Current | N (%) | 340 (13.7) | 308 (26.7) | ||
PHI | At time of CAPI | N (%) | 1,618 (65.4) | 514 (44.6) | <0.001 |
Health-care utilisation
| |||||
No. of GP visits | year pre-CAPI | Median (IQR) | 3 (1,5) | 2 (0, 4) | <0.001 |
Cholesterol test | Ever | N (%) | 2,408 (97.4) | 791 (68.9) | <0.001 |
Influenza Vaccine | Ever | N (%) | 1,352 (54.6) | 468 (40.6) | <0.001 |
No. of medicines | Self-reported | Median (IQR) | 2 (0, 4) | 1 (0, 3) | <0.001 |
BPH-Medicine | N (%) | 166 (4.7) | 21 (1.8) | <0.002 | |
Aspirin | N (%) | 673 (27.2) | 216 (18.7) | <0.001 | |
Statin | N (%) | 869 (35.1) | 277 (24.0) | <0.001 | |
GMS eligibility | At time of CAPI | N (%) | 1,072 (43.3) | 544 (47.2) | 0.029 |
Physical, mental and emotional health
| |||||
Overall health1
| Excellent/Very good | N (%) | 1,398 (56.5) | 601 (52.3) | 0.012 |
Good | N (%) | 690 (27.9) | 376 (32.7) | ||
Fair/Poor | N (%) | 386 (15.6) | 173 (15.0) | ||
No. chronic illnesses | Median (IQR) | 2 (1, 3) | 1 (0,2) | <0.001 | |
Cancer diagnosis | Ever | N (%) | 179 (7.2) | 24 (2.1) | <0.001 |
Prostate cancer | N (%) | 93 (3.8) | 0 (0) | <0.001 | |
Frailty | Not frail | N (%) | 1,265 (51.1) | 486 (42.2) | <0.001 |
Pre-frail | N (%) | 481 (19.5) | 244 (21.2) | ||
Frail | N (%) | 57 (2.3) | 23 (2.0) | ||
Unrecorded | N (%) | 670 (27.1) | 400 (34.7) | ||
Emotional/Mental health1
| Excellent/Very good | N (%) | 1,604 (64.8) | 689 (59.8) | 0.007 |
Good | N (%) | 676 (27.3) | 347 (30.1) | ||
Fair/Poor | N (%) | 195 (7.9) | 117 (10.2) | ||
Depression score | CESD | Median (IQR) | 3 (0, 6) | 3 (1, 8) | 0.001 |
Depression | No | N (%) | 1,954 (79.9) | 847 (74.6) | 0.002 |
Sub-threshold | N (%) | 344 (14.1) | 200 (17.6) | ||
Case-Level | N (%) | 151 (6.2) | 88 (7.8) | ||
Anxiety score | HADS-A (SCQ) | Median (IQR) | 4 (2, 7) | 5 (2, 7) | 0.167 |
Anxiety categorical | Not anxious | N (%) | 1,679 (67.8) | 695 (60.2) | 0.001 |
Borderline | N (%) | 277 (11.2) | 115 (10.0) | ||
Case-Level | N (%) | 118 (4.8) | 75 (6.5) | ||
Unclassified | N (%) | 401 (16.2) | 268 (23.2) | ||
Cognition | MMSE score | Median (IQR) | 29 (27, 30) | 29 (28, 30) | |
MMSE categorical | Normal | N (%) | 1,677 (67.8) | 699 (60.6) | <0.001 |
Mild /moderate Impairment | N (%) | 157 (6.3) | 83 (7.2) | ||
Unrecorded | N (%) | 641 (25.9) | 371 (32.2) |
Stage 1: Core model
Variables associated with PSA testing | Univariate analysis | Multivariate analysis | |||||
---|---|---|---|---|---|---|---|
OR | 95% CI | p-value | OR | 95% CI | p-value | ||
Socio-demographic factors
| |||||||
Age at interview | Years | 1.03 | 1.02-1.04 | <0.001 | 1.02 | 1.00- 1.03 | 0.012 |
Marital status | Married | 1.00 | Ref | 1.00 | Ref | ||
Single | 0.58 | 0.47-0.72 | <0.001 | 0.69 | 0.55-0.87 | 0.001 | |
Separated/Divorced | 0.52 | 0.39-0.70 | <0.001 | 0.68 | 0.50-0.92 | 0.014 | |
Widowed | 0.91 | 0.70-1.18 | 0.466 | 0.70 | 0.53-0.94 | 0.017 | |
Education | Primary | 1.00 | Ref | 1.00 | Ref | ||
Secondary | 1.13 | 0.96-1.33 | 0.131 | 1.31 | 1.09-1.57 | 0.004 | |
Third Level | 1.56 | 1.30-1.88 | <0.001 | 1.49 | 1.22-1.83 | <0.001 | |
Employment | Employed | 1.00 | Ref | 1.00 | Ref | ||
Retired | 1.52 | 1.30-1.78 | <0.001 | 1.23 | 0.99-1.53 | 0.056 | |
Other | 0.51 | 0.42-0.63 | <0.001 | 0.67 | 0.53-0.85 | 0.001 | |
Smoking status | Never | 1.00 | Ref | 1.00 | Ref | ||
Past | 1.05 | 0.89-1.23 | 0.553 | 0.96 | 0.81-1.14 | 0.634 | |
Current | 0.45 | 0.37-0.55 | <0.001 | 0.56 | 0.45-0.69 | <0.001 | |
Private health insurance | Yes | 2.35 | 2.04-2.71 | <0.001 | |||
Healthcare utilisation factors
| |||||||
Number of GP visits | Continuous | 1.04 | 1.02-1.06 | <0.001 | 1.03 | 1.01-1.05 | 0.001 |
Influenza vaccine | Ever | 1.76 | 1.53-2.03 | <0.001 | 1.35 | 1.13-1.60 | 0.001 |
GMS scheme eligible | Yes | 0.86 | 0.74-0.98 | 0.029 | 0.63 | 0.52-0.77 | <0.001 |
Number of medicines | Continuous | 1.12 | 1.08-1.15 | <0.001 | |||
Cholesterol test | Yes | 17.00 | 12.9-22.4 | <0.001 | |||
Physical health
| |||||||
Chronic illnesses | Continuous | 1.25 | 1.19-1.32 | <0.001 | 1.11 | 1.05-1.19 | 0.001 |
Prior cancer diagnosis | Yes | 3.66 | 2.38-5.64 | <0.001 | 2.74 | 1.74-4.30 | <0.001 |
Treated BPH | Yes | 3.87 | 2.45-6.14 | <0.001 | 2.66 | 1.65-4.27 | <0.001 |
Stage 2: associations between psychological and physical health and PSA testing
Physical, mental and emotional health | Univariate analysis | Multivariate analysis | |||||
---|---|---|---|---|---|---|---|
OR | 95% CI | p-value | OR | 95% CI | p-value | ||
Self-rated health
| Excellent/Very good | 1.00 | Ref | 1.00 | Ref | ||
Good | 0.79 | 0.67-0.92 | 0.003 | 0.78 | 0.66-0.93 | 0.005 | |
Fair/Poor | 0.96 | 0.78-1.18 | 0.688 | 0.88 | 0.69-1.38 | 0.320 | |
Self-rated emotional/mental health
| Excellent/Very good | 1.00 | Ref | 1.00 | Ref | ||
Good | 0.84 | 0.72-0.98 | 0.026 | 0.91 | 0.77-1.08 | 0.258 | |
Fair/Poor | 0.72 | 0.56-0.92 | 0.008 | 0.82 | 0.62-1.08 | 0.158 | |
Depression
| CES-D | 0.98 | 0.97-0.99 | 0.002 | 0.99 | 0.98-1.00 | 0.126 |
Depression
| No | 1.00 | Ref | 1.00 | Ref | ||
Sub-threshold | 0.75 | 0.62-0.90 | 0.003 | 0.79 | 0.64-0.97 | 0.025 | |
Case-level | 0.74 | 0.56-0.98 | 0.035 | 0.85 | 0.62-1.15 | 0.293 | |
Anxiety
| Continuous | 0.98 | 0.96-1.00 | 0.078 | 1.00 | 0.97-1.02 | 0.791 |
Anxiety categorical
| Not anxious | 1.00 | Ref | Ref | 1.00 | ||
Borderline | 0.99 | 0.79-1.26 | 0.980 | 1.02 | 0.79-1.30 | 0.906 | |
Case-level | 0.65 | 0.48-0.88 | 0.003 | 0.79 | 0.57-1.09 | 0.159 | |
Unclassified | 0.62 | 0.52-0.74 | <0.001 | 0.71 | 0.59-0.87 | 0.001 | |
Cognition: MMSE score
| Continuous | 1.04 | 1.01-1.08 | 0.023 | 1.05 | 1.01-1.10 | 0.024 |
MMSE score for cognitive impairment
| Unimpaired | 1.00 | Ref | 1.00 | Ref | ||
Mild-moderate | 0.79 | 0.60-1.04 | 0.096 | 0.79 | 0.58-1.08 | 0.134 | |
Unrecorded | 0.72 | 0.62-0.84 | <0.001 | 0.84 | 0.71-1.00 | 0.049 | |
Frailty
| Not frail | 1.00 | Ref | 1.00 | Ref | ||
Pre-frail | 0.76 | 0.62-0.91 | 0.003 | 0.68 | 0.56-0.83 | <0.001 | |
Frail | 0.95 | 0.58-1.56 | 0.846 | 0.61 | 0.35-1.05 | 0.072 | |
Unrecorded | 0.65 | 0.55-0.76 | <0.001 | 0.72 | 0.60-0.85 | <0.001 | |
Arthritis
| 1.59 | 1.32-1.91 | <0.001 | 1.23 | 0.99-1.52 | 0.058 | |
Aspirin
| 1.62 | 1.36-1.92 | <0.001 | 1.18 | 0.96-1.44 | 0.113 | |
Statin
| 1.71 | 1.46-2.00 | <0.001 | 1.28 | 1.06-1.54 | 0.009 |