Role of race/ethnicity, language, and insurance in use of cervical cancer prevention services among low-income Hispanic Women, 2009-2013

John Heintzman, Brigit Hatch, Gloria Coronado, David Ezekiel, Stuart Cowburn, Octavio Escamilla-Sanchez, Miguel Marino

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Article number170267
JournalPreventing chronic disease
Volume15
Issue number2
DOIs
StatePublished - Feb 1 2018

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Insurance
Hispanic Americans
Uterine Cervical Neoplasms
Language
Community Health Centers
Papanicolaou Test
Papillomavirus Vaccines
Insurance Coverage
Confidence Intervals
Electronic Health Records
Vaccination
Cohort Studies
Vaccines
Pregnancy
Population

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Role of race/ethnicity, language, and insurance in use of cervical cancer prevention services among low-income Hispanic Women, 2009-2013. / Heintzman, John; Hatch, Brigit; Coronado, Gloria; Ezekiel, David; Cowburn, Stuart; Escamilla-Sanchez, Octavio; Marino, Miguel.

In: Preventing chronic disease, Vol. 15, No. 2, 170267, 01.02.2018.

Research output: Contribution to journalArticle

Heintzman, John ; Hatch, Brigit ; Coronado, Gloria ; Ezekiel, David ; Cowburn, Stuart ; Escamilla-Sanchez, Octavio ; Marino, Miguel. / Role of race/ethnicity, language, and insurance in use of cervical cancer prevention services among low-income Hispanic Women, 2009-2013. In: Preventing chronic disease. 2018 ; Vol. 15, No. 2.
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abstract = "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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