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Dear editor: With an estimated 1 600 000 new cases and 366 000 deaths every year, prostate cancer (PCa) is the most commonly diagnosed cancer and cancer-related cause of death in men around the world.1 In Mexico, PCa was one of the most common types of cancer diagnosed in men between 2000 and 2013, having one of the highest cancer-related mortality rates.2 It has been pointed out that Mexico lacks a coordinating entity for cancer prevention and control and that the health system is fragmented which has led to inadequate control of patients undergoing PCa testing.3The present study aimed to seek socioeconomical factors associated with frequency of PCa testing in Mexico. We conducted a cross-sectional analysis of 5 339 Mexican males years old from the fourth wave of the Mexican Health and Aging Study (MHAS, 2015).4 Testing activity regarding PCa in the past two years was obtained from a self-reported question. Independent variables included years of education and financial situation. Adjusted multivariate logistic regression model was performed. Following, odds ratio (OR) with a confidence interval (CI) of 95% were obtained.
A 30.9% of the sample reported that had undergone PCa testing within the last two years. Significant differences were found in the bivariate analysis. Subjects that had attended school (7 or 1-7 years) were more commonly tested than those who did not attend it (41.1 vs 46.9 vs 12.0%; p<0.001). Likewise, there was a higher prevalence of subjects with a poor financial situation (70.7 vs 29.3%; p<0.001). Such associations were also found to be significant after model adjustment (Education OR 1.96; CI 1.57 to 2.45; p<0.001; Financial situation OR 0.73; CI, 0.626 to 0.85; p<0.001 [table I]).
table I Multivariate analysis of the Mexican Health and Aging Study fourth wave, 2015
| Variable | OR | CI95% | P value | |||
| Education level | ||||||
| 1-7 years | 1.19 | 0.98-1.46 | 0.075 | |||
| > 7 years | 1.96 | 1.57-2.45 | < 0.001 | |||
| Financial situation | ||||||
| Poor | 0.73 | 0.63-0.85 | < 0.001 | |||
Adjusted by age, depression, cognitive status, number of comorbidities and frailty. Reference categories were no education level and good financial situation (excellent, good or fair).
OR: odds ratio; CI: confidence interval.
These results suggest that education level may be associated with increased awareness of PCa testing and access to PCa testing programs. Similarly, financial status relevance might highlight a disparity in access to and utilization of PCa testing. These findings are consistent with other studies showing that health care utilization among older Mexicans is associated with socioeconomic inequalities.5
A revision of current strategies and public policies allowing a more equal access for all the population could be useful in order to improve current PCa testing practices in Mexico.
