Disability Status Linked With Lower Prostate Cancer Screening Rates

Men with disabilities were significantly less likely to have undergone prostate-specific antigen (PSA) testing than men without disabilities, according to results from a cross-sectional study of the 2023 Behavioral Risk Factor Surveillance System (BRFSS) published in JAMA Network Open.

Among a weighted sample of 5,058,866 US men aged 55 to 69 years, 62.7% (95% CI, 61.1%-64.3%) reported a history of PSA testing. Screening rates were lower among men with any disability than among those without (57.2% [95% CI, 54.2%-60.2%] vs 65.1% [95% CI, 63.2%-67.0%]; P <.001). After adjustment for sociodemographic factors, insurance status, comorbidities, and health behaviors, disability remained associated with lower odds of PSA testing (adjusted odds ratio [aOR], 0.83; 95% CI, 0.69-0.99; P = .046).

Among specific disability types, only mobility disability remained significantly associated with lower screening in adjusted models (aOR, 0.77; 95% CI, 0.62-0.96; P = .02). Cognitive (aOR, 0.86; 95% CI, 0.67-1.10; P = .23), vision (aOR, 0.94; 95% CI, 0.67-1.33; P = .76), hearing (aOR, 0.99; 95% CI, 0.79-1.25; P = .94), and self-care (aOR, 0.77; 95% CI, 0.56-1.06; P = .11) disabilities were all associated with point estimates below 1 but did not reach statistical significance. In an unweighted sensitivity analysis, the association between any disability and lower PSA testing remained significant (OR, 0.86; 95% CI, 0.77-0.98; P = .02), consistent with the primary weighted estimate.

“Physicians should avoid assuming that patients with disabilities may not benefit from screening,” lead author José I. Nolazco, MD, MMSc, a Harvard Medical School Urologic Oncology fellow of the department of Urology at Mass General Brigham and Harvard Medical School, and coauthors wrote in the publication. “Instead, they should explicitly discuss the potential benefits and harms of screening within the context of each patient’s overall health status, life expectancy, and personal priorities.”

The analysis included 10,508 male BRFSS respondents aged 55 to 69 years with complete PSA testing and disability data, in line with US Preventive Services Task Force screening-age recommendations. The mean weighted age among those with disabilities was 62.2 years (SD, 4), of whom 68.2% were White and 49.2% were obese.

Disability status was assessed using the standard 6-question sequence, a validated measure capturing mobility, cognitive, hearing, vision, self-care, and independent living limitations. Overall, a weighted 29.6% (95% CI, 28.1%-31.1%) of participants reported at least 1 disability, most commonly mobility limitations (17.4%; 95% CI, 16.1%-18.6%). Survey-weighted logistic regression models estimated crude and adjusted ORs, with multiple imputation used for missing covariate data.

The primary outcome was self-reported PSA testing history. Secondary analyses assessed differences in screening rates across the 6 individual disability types.

The authors noted several limitations, including the cross-sectional design, which precludes causal inference, and the self-reported nature of PSA testing and disability status, which may introduce recall bias. The BRFSS also lacks life-expectancy data, limiting the ability to determine what portion of lower screening reflects appropriate clinical omission, and excludes institutionalized individuals, potentially underestimating disparities among those with more severe disabilities.

The findings are consistent with a prior national survey analysis that found men with any self-reported disability had approximately 23% lower odds of PSA screening.² The authors pointed to physician bias as one possible contributing factor, citing a 2021 survey in which 59.3% of physicians reported lacking confidence in providing equivalent care to patients with disabilities, with 82.4% agreeing with the premise that patients with significant disabilities experience suboptimal quality-of-life outcomes.³

Reference

1. Nolazco JI, Iezzoni LI, Chen EC, et al. Disability status and prostate cancer screening among US men aged 55 to 69 years. JAMA Netw Open. 2026;9(8):e2627708. doi:10.1001/jamanetworkopen.2026.27708
2. Leong JY, Pinkhasov R, Chandrasekar T, et al. Prostate-specific antigen testing in men with disabilities: a cross-sectional analysis of the Health Information National Trends Survey. Eur Urol Focus. 2022;8(5):1125-1132. doi:10.1016/j.euf.2021.07.009
3. Iezzoni LI, Rao SR, Ressalam J, et al. Physicians' perceptions of people with disability and their health care. Health Aff (Millwood). 2021;40(2):297-306. doi:10.1377/hlthaff.2020.01452