Role of race/ethnicity in Pap-test utilization: A case-control study

OBJECTIVES: To identify factors associated with underutilization of the Pap test, focusing on the differences existing between Latinas and other racial/ethnic groups and between U.S. and foreign-born Latinas.

METHODS: The data for this analysis was obtained from the 2003 Medical Expenditure Panel Survey. Study participants included females 18-64 years of age who reported never having had a hysterectomy. Women who had a Pap test ≤ 5 years, > 5 years ago, and those who had never had a Pap test were compared to those with a recent Pap test (≤3 years). Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between underutilization and race/ethnicity.

RESULTS: The analysis showed that underutilization was associated with being Latina (OR 1.35, 95% CI 1.11-1.64) and Asian (OR 2.26, 95% CI 1.68-3.03); lack a usual source of health care (OR 2.47, 95% CI 2.10-2.90); and low-income status (OR 2.00, 955 CI 1.53-2.35). Comparing U.S. versus foreign-born Latinas, underutilization was 1.6-times (95% CI 1.34-1.93) more likely for non-U.S. born, having no usual source of care (OR 2.08, 95% CI 1.62-2.67) and having low income status (OR 1.98, 1.18-3.31).

CONCLUSIONS: Racial/ethnic disparities continue to exist in Pap-test utilization. Among Latinas, nativity affected utilization. It is therefore important to continue to address these disparities with interventions and healthcare policies aimed at addressing these issues. These results also highlight the importance of addressing health outcome disparities in future research.