TY - JOUR
T1 - Role of race/ethnicity, language, and insurance in use of cervical cancer prevention services among low-income Hispanic Women, 2009-2013
AU - Heintzman, John
AU - Hatch, Brigit
AU - Coronado, Gloria
AU - Ezekiel, David
AU - Cowburn, Stuart
AU - Escamilla-Sanchez, Octavio
AU - Marino, Miguel
N1 - Funding Information:
Drs Heintzman and Marino and Mr Cowburn were supported by K08 HS21522-03 from the Agency for Healthcare Research and Quality. Dr Coronado was supported by the Kaiser Permanente Center for Health Research, and this publication was supported in part by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute through the Cancer Prevention and Control Research Network, a network in CDC's Prevention Research Centers Program (grant no. U48-DP-001911). Dr Hatch was supported by Patient Centered Outcomes Research Institute award no. CDRN-1306-04716. We thank the clinicians, staff, and patients of the OCHIN Practice-Based Research Network for their daily work, which produced the data used for this manuscript.
Publisher Copyright:
© 2018, Centers for Disease Control and Prevention.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - Introduction Hispanic women in the United States have an elevated risk of cervical cancer, but the existing literature does not reveal why this disparity persists. Methods We performed a retrospective cohort analysis of 17,828 low-income women aged 21 to 64 years seeking care at Oregon community health centers served by a hosted, linked electronic health record during 2009 through 2013. We assessed the odds of having had Papanicolaou (Pap) tests and receiving human papillomavirus (HPV) vaccine, by race/ethnicity, insurance status, and language. Results Hispanic women, regardless of pregnancy status or insurance, had greater odds of having had Pap tests than non-Hispanic white women during the study period. English-preferring Hispanic women had higher odds of having had Pap tests than Spanish-preferring Hispanic women (OR, 2.08; 95% confidence interval [CI], 1.63-2.66) but lower odds of having received HPV vaccination (OR, 0.21; 95% CI, 0.12-0.38). Uninsured patients, regardless of race/ethnicity, had lower odds of HPV vaccine initiation than insured patients did. Once a single dose was received, there were no significant racial/ethnic differences in vaccine series completion. Conclusion In this sample of low-income women seeking care at Oregon community health centers, we found minimal racial/ethnic disparities in the receipt of cervical cancer prevention services. Inequities by insurance status, especially in the receipt of HPV vaccine, persist. Community health center-based care may be a useful model to address racial/ethnic disparities in prevention, but this model would need further population-wide study.
AB - Introduction Hispanic women in the United States have an elevated risk of cervical cancer, but the existing literature does not reveal why this disparity persists. Methods We performed a retrospective cohort analysis of 17,828 low-income women aged 21 to 64 years seeking care at Oregon community health centers served by a hosted, linked electronic health record during 2009 through 2013. We assessed the odds of having had Papanicolaou (Pap) tests and receiving human papillomavirus (HPV) vaccine, by race/ethnicity, insurance status, and language. Results Hispanic women, regardless of pregnancy status or insurance, had greater odds of having had Pap tests than non-Hispanic white women during the study period. English-preferring Hispanic women had higher odds of having had Pap tests than Spanish-preferring Hispanic women (OR, 2.08; 95% confidence interval [CI], 1.63-2.66) but lower odds of having received HPV vaccination (OR, 0.21; 95% CI, 0.12-0.38). Uninsured patients, regardless of race/ethnicity, had lower odds of HPV vaccine initiation than insured patients did. Once a single dose was received, there were no significant racial/ethnic differences in vaccine series completion. Conclusion In this sample of low-income women seeking care at Oregon community health centers, we found minimal racial/ethnic disparities in the receipt of cervical cancer prevention services. Inequities by insurance status, especially in the receipt of HPV vaccine, persist. Community health center-based care may be a useful model to address racial/ethnic disparities in prevention, but this model would need further population-wide study.
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U2 - 10.5888/pcd15.170267
DO - 10.5888/pcd15.170267
M3 - Article
C2 - 29470167
AN - SCOPUS:85042628336
VL - 15
JO - Preventing chronic disease
JF - Preventing chronic disease
SN - 1545-1151
IS - 2
M1 - 170267
ER -