Inadequate follow-up for abnormal Pap smears in an urban population.
OBJECTIVE
To determine the factors associated with inadequate follow-up for abnormal Pap smears among a cohort of Boston women from urban academic clinics.


METHODS
Subjects were women > 18 years with abnormal cervical cytology between February 1999 and April 2000. Inadequate follow-up was defined as lack of subsequent cervical cytology or pathology specimen within four months of the initial abnormal specimen for high-grade lesions or within 7 months for low-grade lesions.


RESULTS
Of the 423 subjects, the mean age was 33 years. Sixty percent were black, 23% Hispanic, 15% white, 2% Asian. The population was largely uninsured or publically insured. The overall inadequate follow-up rate was 38%. In bivariate analysis, age was a significant risk factor; 46% of women ages 18-29 had inadequate follow-up (p < 0.01). In multivariate analysis, women aged 18-29 years were more likely than women 50 years and older to have inadequate follow-up (OR 2.7, 95% CI 1.1-6.4), as were women with Medicaid insurance compared with private insurance (OR 1.9, 95% CI 1.01-3.5). After 12 months, 26% of women with abnormal Pap smears still had not received follow-up.


CONCLUSIONS
In a predominantly urban minority population, the overall rate of inadequate follow-up for abnormal Pap smears was high at 38%. Programs to address follow-up of abnormal cervical cytology should focus on minority populations, especially younger and all low-income women.
Peterson
Neeraja B
NB
Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center, Boston, MA, USA. neeraja.peterson@vanderbilt.edu
Han
Jini
J
Freund
Karen M
KM
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001900:Boston / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007341:Insurance / Q000706:statistics & numerical data; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D065006:Papanicolaou Test; D010349:Patient Compliance / Q000706:statistics & numerical data; D012044:Regression Analysis; D014505:Urban Population / Q000706:statistics & numerical data*; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*