Self-reported discrimination in the receipt of health care and cervical cancer screening among low-income women

Objective: Low-income women, particularly racial/ethnic minorities, face significant barriers to accessing health care. Racial and social class discrimination may contribute to these barriers. Our objective is two-fold: 1) to determine whether low-income women are more likely to report discrimination in the receipt of health care and 2) to examine whether self-reported discrimination is associated with lower likelihood of Pap test among low-income women.

Data/Methods: 2001 California Health Interview Survey (CHIS). Unlike the 2003 and 2005 versions of CHIS, the 2001 version asks about discrimination for any reason. Outcome is receipt of a Pap test within the previous 3 years, for women age 18+ (U.S. Preventive Services Task Force guidelines). Self-reported discrimination, our regressor of interest, is based on the question: “Thinking of your experiences with receiving health care in the past 12 months, have you felt you were discriminated against for any reason?” As such, the study included only women reporting a doctor visit in the previous 2 years. Analyses included the following: 1) Logistic regression of income on discrimination, controlling for family status, health status, English proficiency, education, citizenship, poverty, residence, race/ethnicity, age, and insurance status (n=30,200) and 2) logistic regression of discrimination on cervical cancer screening for very low-income women <100% of FPL, controlling for the above covariates (n=4,349). Interaction terms for income and race/ethnicity in the first regression and for discrimination and race/ethnicity in the second regression were not significant and excluded from the models.

Results: Low-income women were significantly more likely to report discrimination (<100% FPL vs. 300%+ FPL OR=1.66, 95%CI 1.27, 2.17). Among low-income women, 7.5% reported discrimination: Whites (8.2%), Latinos (7.1%), Asians (4.2%), and African-Americans (8.8%). Within each racial/ethnic group, women of lower income were more likely to report discrimination than those of higher income (not all differences were significant). In addition, 82.0% of low-income women (<100% FPL), reported a Pap test within the previous 3 years: Whites (78.9%), Latinos (87.0%), Asians (54.7%), African-Americans (90.1%). This is compared to 89.8% among higher income women (300%+ FPL): Whites (90.7%), Latinos (90.2%), Asians (83.1%), African-Americans (93.5%). Self-reported discrimination was not associated, however, with cervical cancer screening for low-income women, controlling for the above covariates.

Conclusion: We found no association of self-reported discrimination and cervical cancer screening in a population of low-income women. Despite no association, self-reported discrimination remains high for many groups and screening rates among low-income women, particularly white and Asian women, remain relatively low.