Department of Family & Community Medicine, University of Toronto, Toronto, Canada.
Med Care. 2010 Jul;48(7):611-8. doi: 10.1097/MLR.0b013e3181d6886f.
Women who are immigrants or socioeconomically disadvantaged have been found to have significantly lower cervical cancer screening rates than their peers in Toronto, Ontario, Canada. The objective of this study was to examine rates of appropriate cervical cancer screening among women living in Ontario, Canada, using recent registration with Ontario's universal health insurance plan as an indicator of immigrant status.
This retrospective cohort study included 2,273,995 screening-eligible women aged 25 to 69 years, who resided in Ontario's metropolitan areas during the calendar years 2003, 2004, and 2005. A validated algorithm was applied to the Ontario-wide physicians' claims database to determine which women had undergone cervical cancer screening with a Pap test during the 3-year period.
Appropriate cervical cancer screening occurred for 61.1% of women. Despite adjustment for physician contact and pregnancy rates, cervical cancer screening rates were especially low among: women aged 50 to 69 years; women living in low-income areas; and women who had registered with Ontario's universal health insurance plan within the preceding 10 years, a group consisting largely of recent immigrants. Women with all 3 of these characteristics had a screening rate of 31.0% compared with 70.5% among women with none of these characteristics.
Within a system of universal health insurance, appropriate cervical cancer screening is significantly lower among women who are older, living in low-income areas, or recent immigrants. Efforts to reduce disparities in cervical cancer screening should focus on women with these characteristics.
在加拿大安大略省多伦多，与同龄人相比，移民或社会经济地位较低的女性宫颈癌筛查率明显较低。本研究的目的是通过最近登记安大略省全民健康保险计划来检查加拿大安大略省女性的适当宫颈癌筛查率，以确定移民身份。
本回顾性队列研究包括 2273995 名符合筛查条件的 25 至 69 岁女性，这些女性在 2003 年、2004 年和 2005 年期间居住在安大略省的大都市区。使用经过验证的算法对安大略省的医生索赔数据库进行分析，以确定哪些女性在 3 年内接受过巴氏涂片宫颈癌筛查。
61.1%的女性进行了适当的宫颈癌筛查。尽管对医生接触和妊娠率进行了调整，但以下女性的宫颈癌筛查率尤其低：年龄在 50 至 69 岁之间的女性；居住在低收入地区的女性；以及在过去 10 年内登记安大略省全民健康保险计划的女性，这些女性主要是新移民。具有所有这 3 个特征的女性的筛查率为 31.0%，而没有这些特征的女性的筛查率为 70.5%。
在全民健康保险制度下，年龄较大、生活在低收入地区或新移民的女性接受适当宫颈癌筛查的比例明显较低。减少宫颈癌筛查差异的努力应侧重于具有这些特征的女性。
