OCHIN, Inc, 1881 SW Naito Parkway, Portland, Oregon 97201. E-mail:
Prev Chronic Dis. 2013 Oct 24;10:E173. doi: 10.5888/pcd10.130034.
Cervical cancer incidence and mortality rates in the United States have decreased 67% over the past 3 decades, a reduction mainly attributed to widespread use of the Papanicolaou (Pap) test for cervical cancer screening. In the general population, receipt of cervical cancer screening is positively associated with having health insurance. Less is known about the role insurance plays among women seeking care in community health centers, where screening services are available regardless of insurance status. The objective of our study was to assess the association between cervical cancer screening and insurance status in Oregon and California community health centers by using data from electronic health records.
We used bilevel log-binomial regression models to estimate prevalence ratios and 95% confidence intervals for receipt of a Pap test by insurance status, adjusted for patient-level demographic factors and a clinic-level random effect.
Insurance status was a significant predictor of cervical cancer screening, but the effect varied by race/ethnicity and age. In our study uninsured non-Hispanic white women were less likely to receive a Pap test than were uninsured women of other races. Young, uninsured Hispanic women were more likely to receive a Pap test than were young, fully insured Hispanic women, a finding not previously reported.
Electronic health records enable population-level surveillance in community health centers and can reveal factors influencing use of preventive services. Although community health centers provide cervical cancer screening regardless of insurance status, disparities persist in the association between insurance status and receipt of Pap tests. In our study, after adjusting for demographic factors, being continuously insured throughout the study period improved the likelihood of receiving a Pap test for many women.
过去 30 年来，美国的宫颈癌发病率和死亡率下降了 67%，这主要归因于巴氏涂片（Pap）检测在宫颈癌筛查中的广泛应用。在普通人群中，接受宫颈癌筛查与拥有医疗保险呈正相关。在社区卫生中心寻求医疗服务的女性中，医疗保险在宫颈癌筛查中的作用知之甚少，在这些中心，无论保险状况如何，都可以提供筛查服务。我们的研究目的是使用电子健康记录中的数据，评估俄勒冈州和加利福尼亚州社区卫生中心中宫颈癌筛查与保险状况之间的关联。
我们使用双层对数二项式回归模型，根据患者水平的人口统计学因素和诊所水平的随机效应，调整了保险状况对巴氏涂片检测的接受情况的优势比和 95%置信区间。
保险状况是宫颈癌筛查的一个显著预测因素，但这种影响因种族/民族和年龄而异。在我们的研究中，未参保的非西班牙裔白人女性接受巴氏涂片检测的可能性低于其他种族的未参保女性。未参保的年轻西班牙裔女性比完全参保的年轻西班牙裔女性更有可能接受巴氏涂片检测，这一发现以前没有报道过。
电子健康记录使社区卫生中心能够进行人群水平的监测，并能够揭示影响预防服务使用的因素。尽管社区卫生中心提供宫颈癌筛查，无论保险状况如何，但在保险状况与巴氏涂片检测接受情况之间仍然存在差异。在我们的研究中，在调整人口统计学因素后，在整个研究期间连续参保提高了许多女性接受巴氏涂片检测的可能性。
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