Access of Black, Hispanic, and Nonprivately Insured Women to Liquid-Based Cytology, Human Papillomavirus DNA Testing, and On-Site Colposcopy in the United States

作者：Hoover Karen^*; Koumans Emilia H; Montano Daniel; Kasprzyk Danuta; Freeman Crystal; Greek Apird; Jain Nidhi; Irwin Kathleen

来源：Journal of Lower Genital Tract Disease, 2009, 13(1): 17-27.

DOI：10.1097/lgt.0b013e318194b87e

• access
• Pap test
• liquid-based cytology
• HPV test
• colposcopy

Objective. To determine whether patient race, ethnicity, or insurance status was associated with access to cervical cancer screening with liquid-based cytology (LBC) and with human papillomavirus (HPV) DNA testing and with access to on-site colposcopy at the provider's principal practice site.
Materials and Methods. We conducted a nationally representative survey of clinicians in specialties that provide cervical cancer screening. Adjusted odds ratios (OR) were estimated for the associations between race, ethnicity, and insurance status of patients and provider use of LBC, HPV DNA testing, and on-site colposcopy.
Results. Providers who cared for >= 20% Hispanic patients were less likely to use LBC (OR 0.60, 95% CI = 0.42-0.84). Providers who cared for >= 25% black women (OR 0.71, 95% CI = 0.51-0.98) and providers who cared for <75% privately insured patients (OR 0.66, 95% Cl = 0.46-0.95) were less likely to use HPV DNA testing. Providers who cared for <75% privately insured patients were less likely to have on-site colposcopy (OR 0.57, 95% CI = 0.37-0.89), but those who cared for >= 20% Medicaid patients were more likely to have on-site colposcopy (OR 1,86, 95% CI = 1.26-2.73).
Conclusions. Given the high rates of cervical cancer in minority women, access to cervical cancer screening and diagnostic follow-up must be ensured. It may also be beneficial to ensure affordable access to technologies such HPV DNA testing that increases the sensitivity of disease detection and to on-site colposcopy that facilitates follow-up of abnormal cytology.

• 出版日期2009-1