Santamaría-Ulloa Carolina, Quirós-Rojas Ileana, Montero-López Melina, Quesada-Leitón Hazel
Instituto de Investigaciones en Salud, Universidad de Costa Rica, San Jose, Costa Rica.
Coordinacion Tecnica del Cancer, Caja Costarricense del Seguro Social, San Jose, Costa Rica.
Front Oncol. 2021 Jun 15;11:642841. doi: 10.3389/fonc.2021.642841. eCollection 2021.
Every year about 83,000 women are diagnosed with cervical cancer in the Americas. Latin America and the Caribbean (LAC) has one of the highest incidence and mortality rates from cervical cancer in the world. Although incidence has decreased by half in the last 30 years, cervical cancer remains a public health concern. The detection of precursor lesions through Papanicolaou (Pap) smear remains a critical tool in the context of prevention in Costa Rica and many other LAC countries.
To determine predictors of participation in Pap smear screening among Costa Rican women, with a special focus on women who have never had a Pap smear or have had a smear 5 or more years ago.
The data source for this study is the Costa Rican Households National Survey conducted in 2014. This survey is representative at the national, urban/rural zone, and administrative region level. A subsample of women aged 20 to 69 years who responded to the survey's Papanicolaou Module were included in this study (n = 11,709). Statistical analyses were conducted in R-Studio. Statistical significance level was set at 5%. Two multinomial regression models were estimated. The first model aimed to explain the five different categories of cytology use, which were defined according to the last time women had a Pap smear. The second model aimed to explain the five different categories of reasons why women had never had a Pap smear. Both models controlled for age, educational attainment, and marital status.
Young women with high educational attainment were more likely to have never had a cytology. Women with a lower educational attainment, married, or in domestic relationship and of older age had greater odds of having had a cytology 5 or more years ago. Each year increment in age was significantly associated with an increase in the odds of never having a Pap smear because of health care access issues or because of cultural reasons as compared to not having an active sexual life.
Findings can inform public policy targeted to higher risk female populations where access to health services can be improved.
在美洲，每年约有83,000名女性被诊断出患有宫颈癌。拉丁美洲和加勒比地区（LAC）是世界上宫颈癌发病率和死亡率最高的地区之一。尽管在过去30年中发病率下降了一半，但宫颈癌仍然是一个公共卫生问题。通过巴氏涂片检测前体病变仍然是哥斯达黎加和许多其他LAC国家预防工作中的关键工具。
确定哥斯达黎加女性参与巴氏涂片筛查的预测因素，特别关注从未进行过巴氏涂片或在5年或更久以前进行过涂片的女性。
本研究的数据来源是2014年进行的哥斯达黎加家庭全国调查。该调查在国家、城乡地区和行政区层面具有代表性。本研究纳入了对调查的巴氏模块做出回应的20至69岁女性子样本（n = 11,709）。在R-Studio中进行统计分析。统计显著性水平设定为5%。估计了两个多项回归模型。第一个模型旨在解释根据女性最后一次进行巴氏涂片的时间定义的细胞学使用的五个不同类别。第二个模型旨在解释女性从未进行过巴氏涂片的五个不同原因类别。两个模型都控制了年龄、教育程度和婚姻状况。
高学历的年轻女性更有可能从未进行过细胞学检查。学历较低、已婚或处于家庭关系中的老年女性在5年或更久以前进行过细胞学检查的几率更高。与没有活跃性生活相比，年龄每增加一岁，因医疗保健获取问题或文化原因从未进行过巴氏涂片的几率显著增加。
研究结果可为针对可改善医疗服务获取情况的高风险女性人群的公共政策提供参考。
