Khurana Sonia, Smolar Isaiah, Warren Leslie, Velasquez Jessica, Kaplowitz Elianna, Rios Jeanette, Pero Adriana, Roberts Harley, Mitchell Mackenzie, Oner Ceyda, Abraham Cynthia
Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System, New York, NY.
Department of Population Health Science and Policy, Icahn School of Medicine, New York, NY.
J Low Genit Tract Dis. 2024 Jul 1;28(3):217-223. doi: 10.1097/LGT.0000000000000812. Epub 2024 May 2.
Screening and diagnostic follow-up to prevent cervical cancer are influenced by socioeconomic and systemic factors. This study sought to characterize intervals from abnormal cervical cancer screening to colposcopy between practices differing by insurance status at a large, urban academic center.
This retrospective cohort study included patients aged 21-65 who presented for colposcopy between January 1, 2021, and January 1, 2022, at the resident and faculty gynecology practices of a single large urban academic medical center. Patient characteristics were compared using t tests or Wilcoxon rank sum tests for continuous measures and χ 2 or Fisher exact tests for categorical measures. Intervals from abnormal cervical cancer screening to colposcopy were compared using the Wilcoxon rank sum test and linear regression analysis with multivariable models adjusted for age, cervical cytology result, human papillomavirus result, and HIV status.
Resident practice patients were publicly insured and more likely to be Black or Hispanic ( p < .0001); rates of high-risk human papillomavirus and smoking were similar. Resident practice patients had longer intervals from abnormal cervical cancer screening to colposcopy compared with faculty practice patients (median 79.5 vs 34 d, p < .0001). On adjusted analysis, resident practice patients faced a 95% longer interval ( p < .0001).
Publicly insured patients of a resident-based practice faced significantly longer intervals from abnormal cervical cancer screening to colposcopy than faculty practice patients at a single urban academic center. Effort to address these differences may be an area of focus in improving health disparities.
宫颈癌的筛查及诊断后续措施会受到社会经济和系统因素的影响。本研究旨在描述在一个大型城市学术中心，不同保险状态的医疗机构中，从宫颈癌筛查异常到阴道镜检查的间隔时间特征。
这项回顾性队列研究纳入了2021年1月1日至2022年1月1日期间在一个大型城市学术医疗中心的住院医师和妇科教员诊所接受阴道镜检查的21至65岁患者。连续变量采用t检验或Wilcoxon秩和检验，分类变量采用χ²检验或Fisher精确检验来比较患者特征。采用Wilcoxon秩和检验和线性回归分析比较从宫颈癌筛查异常到阴道镜检查的间隔时间，并建立多变量模型，对年龄、宫颈细胞学结果、人乳头瘤病毒结果和HIV状态进行校正。
住院医师诊所的患者参加公共保险，且更有可能是黑人或西班牙裔（p <.0001）；高危人乳头瘤病毒感染率和吸烟率相似。与教员诊所的患者相比，住院医师诊所的患者从宫颈癌筛查异常到阴道镜检查的间隔时间更长（中位数分别为79.5天和34天，p <.0001）。经校正分析，住院医师诊所的患者间隔时间长95%（p <.0001）。
在单一城市学术中心，基于住院医师的诊所中参加公共保险的患者从宫颈癌筛查异常到阴道镜检查的间隔时间明显长于教员诊所的患者。解决这些差异的努力可能是改善健康差距的一个重点领域。
