ASPO Abstracts
Logistic Regression for Cervical Cancer Risk Prediction for Haitian Women in South Florida
Category: Cancer Health Disparities
Conference Year: 2020
Abstract Body:
Objective/Purpose:
This study seeks to assess risk for cervical cancer in a sample of Haitian women living in South
Florida, the largest U.S. enclave of Haitians.
Methods:
Extracted and merged from two studies, this sample includes N=346 at-risk Haitian women
(ages 30-65 and unscreened in previous three years). To craft the most parsimonious model,
data analysis included a manual hierarchal stepwise approach to Logisitic regression (LR)
which allowed selection of variables by the PEN-3 Cultural Model and meaningfulness.
Analyses focus on the association between screening history and predictors including
immigration history, health care utilization patterns, and key sociodemographic variables.
Results:
The sample included women who were on average 46 years of age (interquartile range= 39, 53;
median=46; SD=9.2) with 30.5 years spent in the U.S. (interquartile range= 8, 47; median=36;
SD=20.4). Women displayed low levels of citizenship (23.1%), insurance (19.4%), access to
routine care (22.0%), and employment (28.3%). Slightly more than half of the sample was
married (56.1%) with less than high-school education (57.4%). Although none of the women
adhered to U.S. recommendations of undergoing Pap smear screening every three years,
approximately two thirds of the sample (N=226; 65.3%) had history of a previous Pap smear in
general. The ultimate model was selected according to the PEN-3 Cultural Model and
parsimony (AIC=367.5) with age, citizenship, access to routine care, and education as
predictors. Ultimately, women reporting middle (OR=2.2, 95% CI= 1.17, 4.17) or older age
(OR=1.96, 95% CI=.98, 3.94), U.S. citizenship (OR=4.11, 95% CI=1.83, 9.26), and access to
routine care (OR=2.69, 95% CI= 1.26, 5.71) were most likely to report a previous history of Pap
smear screening with a C-statistic of 73%.
Discussion/Conclusion:
Results highlight the importance of routine access to healthcare services in prevention and
control of cervical cancer. Notably, reports of access to routine care outperformed insurance in
analyses. Reports of non-citizenship were the strongest predictors of screening history in both
bivariate and multivariate analyses. Additionally, results suggest women with recent immigration
years are less likely to undergo screening. Immigrants
Keywords: systems thinking, women's health, health equity