ASPO Abstracts
Patterns and determinants of abnormal cervical cancer screening follow-up and invasive cervical cancer among uninsured and underinsured women in New Jersey
Category: Cancer Health Disparities, Early Detection & Risk Prediction
Conference Year: 2018
Abstract Body:
Purpose: Lack of timely and appropriate follow-up care after receipt of an abnormal Pap result have been attributed to higher invasive cervical cancer (ICC) incidence and mortality rates among underserved women. We examined healthcare environment-related determinants of follow-up care and diagnosis of ICC among uninsured and underinsured women in New Jersey to inform system-level strategies for care improvement. Methods: We conducted a retrospective cohort study of women in the New Jersey Cancer Education and Early Detection (NJCEED) Program with at least one Pap test between 2000 and 2015 (n=90,322). Data from the New Jersey State Cancer Registry (NJSCR) on ICC cases were linked to the NJCEED cohort data. Using generalized estimating equations for clustering at the county level, we examined the association between healthcare facility, area-level characteristics, and individual sociodemographic factors on receipt of an abnormal Pap test, receipt of any follow-up care, treatment delays, and diagnosis of ICC. Results: The majority of women in the NJCEED cohort were 40 years (73%), racial/ethnic minorities (74%), and foreign-born from Central/South American or Caribbean countries (69%). Of the 9,688 women with at least one abnormal Pap test, 36% required follow-up and 13% never received follow-up. The odds of not receiving follow-up care after an abnormal Pap test were independently associated with screening facility type, country of birth, number of prior Pap tests, prior NJCEED encounters, and neighborhood-level unemployment. A total of 185 NJCEED participants were diagnosed with ICC and 42% (n=77) were cases with 1 abnormal Pap test that required follow-up. Conclusions: Although the majority of NJCEED participants received timely treatment, we observed significant variation in the receipt of needed follow-up care, delays in care, and ICC diagnosis by screening facility type and place of care, which are healthcare system related factors that have been inadequately examined in prior studies. Even with the implementation of patient navigation services, multilevel barriers to appropriate follow-up care continue to persist and warrant localized focus within the healthcare system.
Keywords: cervical cancer screening; follow-up care; minority populations; medically underserved; uninsured