Racial and Ethnic Disparities in Cervical Cancer Screening From Three U.S. Healthcare Settings.

Autor: Spencer JC; Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas; Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, Texas. Electronic address: Jennifer_spencer@austin.utexas.edu., Kim JJ; Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, Massachussetts., Tiro JA; Department Public Health Sciences, The University of Chicago, Chicago, Illinois; University of Chicago Medicine Comprehensive Cancer Center, The University of Chicago, Chicago, Ilinois., Feldman SJ; Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachussetts., Kobrin SC; Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Bethesda, Maryland., Skinner CS; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas., Wang L; Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas., McCarthy AM; Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, Pennsylvania., Atlas SJ; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachussetts., Pruitt SL; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas., Silver MI; Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri., Haas JS; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachussetts.
Jazyk: angličtina
Zdroj: American journal of preventive medicine [Am J Prev Med] 2023 Oct; Vol. 65 (4), pp. 667-677. Date of Electronic Publication: 2023 May 03.
DOI: 10.1016/j.amepre.2023.04.016
Abstrakt: Introduction: This study sought to characterize racial and ethnic disparities in cervical cancer screening and follow-up of abnormal findings across 3 U.S. healthcare settings.
Methods: Data were from 2016 to 2019 and were analyzed in 2022, reflecting sites within the Multi-level Optimization of the Cervical Cancer Screening Process in Diverse Settings & Populations Research Center, part of the Population-based Research to Optimize the Screening Process consortium, including a safety-net system in the southwestern U.S., a northwestern mixed-model system, and a northeastern integrated healthcare system. Screening uptake was evaluated among average-risk patients (i.e., no previous abnormalities) by race and ethnicity as captured in the electronic health record, using chi-square tests. Among patients with abnormal findings requiring follow-up, the proportion receiving colposcopy or biopsy within 6 months was reported. Multivariable regression was conducted to assess how clinical, socioeconomic, and structural characteristics mediate observed differences.
Results: Among 188,415 eligible patients, 62.8% received cervical cancer screening during the 3-year study period. Screening use was lower among non-Hispanic Black patients (53.2%) and higher among Hispanic (65.4%,) and Asian/Pacific Islander (66.5%) than among non-Hispanic White patients (63.5%, all p<0.001). Most differences were explained by the distribution of patients across sites and differences in insurance. Hispanic patients remained more likely to screen after controlling for a variety of clinical and sociodemographic factors (risk ratio=1.14, CI=1.12, 1.16). Among those receiving any screening test, Black and Hispanic patients were more likely to receive Pap-only testing (versus receiving co-testing). Follow-up from abnormal results was low for all groups (72.5%) but highest among Hispanic participants (78.8%, p<0.001).
Conclusions: In a large cohort receiving care across 3 diverse healthcare settings, cervical cancer screening and follow-up were below 80% coverage targets. Lower screening for Black patients was attenuated by controlling for insurance and site of care, underscoring the role of systemic inequity. In addition, it is crucial to improve follow-up after abnormalities are identified, which was low for all populations.
(Copyright © 2023 American Journal of Preventive Medicine. All rights reserved.)
Databáze: MEDLINE
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