208896 Is health care coverage contributing to cervical cancer screening follow-up among Colombian women?

Monday, November 9, 2009: 1:42 PM

Isabel Garces, DrPH, MPH , Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
Maja Altarac, MD, MPH, PHD , Department of Maternal and Child Health, University of Alabama at Birmingham, Birimingham, AL
Russ Kirby, PhD, MS, FACE , Department of Community and Family Health, USF College of Public Health, Tampa, FL
Leslie A. McClure, PhD , Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
Beverly A. Mulvihill, PhD , Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL
Isabel C. Scarinci, PhD, MPH , Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
BACKGROUND: In Colombia, cervical cancer (CC) is the most common cancer among women with incidence (36.4/100,000) and mortality rates (18/100,000) much higher than for the U.S. (7.7 and 2.3 respectively). About 70% of the Colombian population has health care coverage (HCC) through the subsidized regime (SR) which serves the poorest, or the contributory regime (CR) for the working population.

OBJECTIVE: To determine the role that HCC plays in CC screening follow-up among Colombian women.

METHODS: Population-based cross-sectional study of 24,717 women age 18-49, using the 2005 Demographic and Health Survey. CC screening follow-up was measured as seeking Pap smear results and follow-up of abnormal results.

RESULTS: About 38% were enrolled with the CR, 34.2% with the SR, and 27.8% did not have coverage. Women without HCC and those in SR were less likely to seek Pap smear results than women in CR even after adjusting for socio-demographic factors (ORa:0.51; 95%CI:0.42,0.62 and ORa:0.68; 95%CI:0.56,0.84, respectively). Similar results were found for follow-up of abnormal results (ORa:0.71; 95%CI:0.54,0.95 and ORa:0.75; 95%CI:0.57,0.98). Other variables associated with seeking results/follow-up were: wealth index, Pap smear payment, geographic region, perceived health, and health-care visit within last year.

CONCLUSIONS: Women without HCC and in the SR were less likely to have CC screening follow-up than women in the CR. Screening alone is not sufficient to reduce mortality, adequate follow-up care is crucial. Universal health care coverage for all women may not be realistic. However, we can start improving cervical cancer prevention services for those enrolled with the SR.

Learning Objectives:
1. To describe the role that health care coverage has in the follow-up of cervical cancer screening among Colombian women. 2. To identify other factors associated with cervical cancer screening follow-up.

Keywords: Cancer Screening, Access to Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: It is the topic of my dissertation as a candidate for a DrPH.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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