The Impact of Area Deprivation Index on Receiving Appropriate Work-up on Patients Presenting with an Elevated PSA
Recommended Citation
Santangelo A, Silvani C, Stephens A, Haddad L, Shafau F, Kumar N, Salka B, Considine J, Catanzaro M, Nicolai N, Montanari E, Salonia A, Montorsi F, Rogers C, Abdollah F. The Impact of Area Deprivation Index on Receiving Appropriate Work-up on Patients Presenting with an Elevated PSA. Eur Urol 2026; 89.
Document Type
Conference Proceeding
Publication Date
3-1-2026
Publication Title
Eur Urol
Keywords
prostate specific antigen, adult, aged, Charlson Comorbidity Index, conference abstract, controlled study, drug therapy, female, follow up, human, major clinical study, male, MRI scanner, neighborhood, nuclear magnetic resonance imaging, prostate cancer, race, retrospective study, socioeconomics
Abstract
Introduction & Objectives: The role of PSA in prostate cancer (PCa) screening remains controversial. However, guidelines have always clearly established that a patient with an elevated PSA (≥4 ng/ml) needs further diagnostic work-up. Socioeconomic factors could affect the likelihood of receiving high-quality care, including appropriate work-up for an elevated PSA. Our aim was to examine the impact of Area Deprivation Index (ADI - a validated measure of the level of deprivation of a specific neighborhood) on receiving appropriate work-up in patients with elevated PSA. Materials & Methods: We included 26,505 patients who received a PSA test at one of Henry Ford Health System facilities between 1995 and 2023 and who resulted with a PSA >4 ng/ml. Patients were characterized on the base of their ADI percentile respect to the national values. ADI is a single score that incorporates 17 census-derived socioeconomic variables that reflects how socially and economically disadvantaged a neighborhood is. The higher the ADI, the more disadvantaged the neighborhood. The primary endpoint was receipt of an Appropriate Diagnostic Work-Up, defined as repeat PSA within 6 months and/or MRI or biopsy within 12 months after the abnormal result. Patients with less than 1 year of follow-up were excluded by the analysis. A logistic regression tested ADI as predictor of appropriate work-up after adjusting for PSA value, age, race, Charlson Comorbidity Index (CCI) and ordering department. Results: Of 26,505 patients, less than half (45.6%) received an Appropriate Diagnostic Work-Up. Median PSA was 5.3 (IQR 4.5 – 7.2) ng/ml and median age 65 (IQR 59-70) years. Patients in the first ADI percentile were younger (Median [IQR]: 64 [58-69] vs 65 [59-70]) and had lower median PSA (5.1 [4.4-6.6] ng/ml vs 5.5 [4.6-8] ng/ml), when compared to the fourth quartile group. Appropriate work-up percentage was 47.9%, 45.8%, 43%, 46.8% in the first, second, third and fourth quartile. At the multivariable analysis ADI emerged as independent predictor of receiving an Appropriate work-up. Particularly, for every 5 percentiles increase in ADI, patients were 2% less likely to receive an appropriate work-up (OR 0.98, p<0.001). Conclusions: ADI emerged to be an important predictor of appropriate follow-up. Patients living in more deprived areas seems to be exposed to higher risk of inappropriate follow-up thus underlying consistent socio-economic disparities in access to proper clinical care.
Volume
89
