Leveraging Population-Level and Multipayer Claims Data to Estimate Changes in Prostate Cancer Screening at the Small-Area Level

PURPOSE: In 2018, the US Preventive Services Task Force (USPSTF) updated its prostate cancer screening recommendations for men age 55-69 years from grade D, discouraging screening, to grade C, supporting individualized decision making based on clinician judgment and patient preference. Although one study reported increased screening after the 2017 draft recommendation, findings were based on privately insured populations. This study assessed changes in screening after USPSTF revisions in Colorado, examining variation by payer and area-level social determinants of health. METHODS: Using Colorado's All-Payer Claims Database, we included men age 55-69 years with continuous annual enrollment between 2014 and 2023 and measured prostate screening procedures. Negative binomial regression models with population offsets and spline knots in 2016 and 2018 estimated changes in screening, adjusting for age and year, and clustering at the Zip Code Tabulation Area level. Data from 2020 were not used in the model because of pandemic-related disruptions. Analyses were stratified by payer. To assess geographic variation, we estimated random-effects negative binomial models and examined associations between predicted screening changes and the social deprivation index. RESULTS: In a sample of over 2 million person-years, 595,107 (27.8%) were screened during the study period. Screening rates increased steadily across all payers, rising from 23.1% in 2014 to 32.1% in 2023, with the largest gains among Medicare Advantage and commercial enrollees. Increases varied geographically, with smaller gains in areas with higher deprivation levels, in particular, areas with poverty, low educational attainment, and crowded housing. CONCLUSION: Prostate cancer screening increased after recommendation revisions across all payers, but the magnitudes and trajectories varied. Our results suggest barriers to screening among eligible and insured men associated with socioeconomic factors.