National trends and disparities in cervical cancer screening among commercially insured Women, 2001-2010.

BACKGROUND: Previous surveys reported declining cervical cancer screening rates from 2000 to 2010, but trends by key demographic and age groups are less clear. METHODS: We examined 3-year Papanicolaou (Pap) test rates among 4.2 million women enrolled in a large national health plan during 2001 to 2010. We calculated and plotted adjusted 3-year rates stratified by age and key neighborhood-level socioeconomic characteristics including poverty level and race/ethnicity (white, black, Hispanic, and mixed ethnicity neighborhood). We fitted trends in 2001-2010 screening rates and socioeconomic disparities as annual percentage changes (APC) using joinpoint analysis. RESULTS: Women ages 21 to 29 years had estimated 3-year Pap testing rates of 81.3% to 81.4% over the decade. Estimated disparities by low-high poverty level were 3.1% and 2.0% in 2001-2003 and 2008-2010, respectively, a nonsignificant decline. Initial white-black disparities were 4.0% and declined significantly from 2005-2007 to 2008-2010 to 2.8% at an APC of -0.65% (P = 0.021). White-Hispanic disparities declined from 4.3% to 0.8% over the decade, a -0.50% APC (P = 0.024). Among women ages 30 to 64 years, estimated 3-year Pap testing rates trended down from 76.1% to 71.8% over the decade [-0.94% APC (P < 0.001) until 2005-2007]. This pattern was similar among women from most categories of poverty and race/ethnicity. CONCLUSIONS: Among commercially insured women ages 21 to 29 years, 3-year Pap testing rates remained stable at 81% over the decade; disparities were small and improved for Hispanic women to a greater degree than for black women. Among women ages 30 to 64 years, 3-year Pap testing rates declined from 2001 to 2010. IMPACT: Cervical cancer screening should be promoted to achieve Healthy People 2020 goals.

Duke Scholars

Author J. Franklin Wharam Medicine, General Internal Medicine