Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
J Obstet Gynaecol. 2024 Dec;44(1):2393359. doi: 10.1080/01443615.2024.2393359. Epub 2024 Aug 23.
To assess if implementation of the 2010 Patient Protection and Affordable Care Act (ACA) was associated with changes in the prevalence of women having ever received a pap smear.
This study utilised the publicly available Centre for Disease Control National Survey of Family Growth (NSFG) data set. This was a serial cross-sectional study. The comparison groups were defined as women who received cancer screening and prevention interventions prior to full implementation of the ACA (2011-2013) and post full implementation (2017-2019). The primary outcome was self-reporting receipt of a Papanicolaou (Pap) smear. Secondary outcomes included HPV vaccination and mammogram rates. Anonymized patient information was collected from the nationally representative dataset, and analyses were performed utilising STATA 18.
The two study cohorts obtained from the NSFG included women who responded in 2011-2013 ( = 5601), deemed to be 'Pre-ACA implementation' (Pre ACA), and those who responded in 2017-2019 ( = 6141) 'Post-ACA implementation' (Post ACA). The proportion of women who were 21 years and older and ever had a Pap smear in the Pre ACA group (96.0%) was higher than that of the Post ACA group (94.1%) (OR 0.66 (0.49-0.91)). In contrast, HPV vaccination rates rose, and mammogram rates remained stable in the Post ACA period.
A decrease in proportion of women ever having had a Pap smear despite implementation of health policies to increase access to preventive measures suggests further interventions to improve access to cervical cancer screening are warranted.
评估 2010 年《患者保护与平价医疗法案》（ACA）的实施是否与曾接受巴氏涂片检查的妇女人数的变化有关。
本研究利用了公开的疾病控制与预防中心国家家庭增长调查（NSFG）数据集。这是一项连续的横断面研究。比较组定义为在 ACA 全面实施之前（2011-2013 年）和全面实施之后（2017-2019 年）接受癌症筛查和预防干预的妇女。主要结局是自我报告接受巴氏涂片检查。次要结局包括 HPV 疫苗接种和乳房 X 光检查率。从全国代表性数据集中收集匿名患者信息，并使用 STATA 18 进行分析。
从 NSFG 获得的两个研究队列包括在 2011-2013 年做出回应的妇女（n=5601），被认为是“ACA 实施前”（Pre ACA），以及在 2017-2019 年做出回应的妇女（n=6141）“ACA 实施后”（Post ACA）。在 Pre ACA 组中，21 岁及以上且曾接受过巴氏涂片检查的妇女人数比例（96.0%）高于 Post ACA 组（94.1%）（OR 0.66（0.49-0.91））。相比之下，HPV 疫苗接种率上升，而乳房 X 光检查率在 Post ACA 期间保持稳定。
尽管实施了增加获得预防措施的机会的卫生政策，但曾接受巴氏涂片检查的妇女人数比例下降，这表明需要进一步干预措施来改善宫颈癌筛查的获得。
