Neighborhood poverty and cervical cancer screening among low-income women in California

Background: Low-income women face significant barriers to accessing quality health care, including cervical cancer screening. Despite strong evidence of the disparity in screening rates among low-income women, less has been studied on the effects of neighborhood socioeconomic status on rates.

Objective: To determine whether neighborhood poverty is a predictor of screening and whether low-income women fare better in low-income neighborhoods (a result of social support and targeted resources) or in higher income neighborhoods (a result of the overall quality and quantity of resources).

Data/Methods: 2005 California Health Interview Survey and 2000 Census. Logistic regression of neighborhood poverty on Pap test, controlling for individual poverty, education, citizenship, family status, race/ethnicity, English proficiency, residence, health status, smoking, insurance, and distance to nearest safety net clinic (n=16,659). Population includes women, 18-64, without a history of hysterectomy or cervical cancer.

Results: Controlling for the above covariates, low-income women (0-99% FPL) were significantly less likely to have a Pap test in the previous 3 years than higher income women (300%+ FPL) (78.4% vs. 89.0%). Differences were also significant for women in neighborhoods with <5% (76.7% vs. 89.8%) and 5-20% (79.6% vs. 88.5%) of the population at/below poverty. No significant difference was found for neighborhoods with >20% of the population in poverty.

Conclusion: Screening rates remain relatively low among lower-income women. Rates between higher and lower income women converged in higher poverty neighborhoods, suggesting that neighborhood economic deprivation may impose an intractable barrier to screening that even higher income women living in these neighborhoods cannot overcome.