Health insurance and cervical cancer screening among older women in Latin American and Caribbean cities.
BACKGROUND
The purpose of this study is to describe the prevalence of Papanicolaou (Pap) smear use for cervical cancer screening and to estimate its association with type of health care insurance.


METHODS
A cross-sectional study using data from the Health, Well-Being and Aging in Latin America and the Caribbean Study (SABE). The sample includes 6357 women aged 60 and older from seven cities. The outcome was reporting a Pap smear for cervical cancer screening during the previous 2 years. Main independent variable was health care insurance. Covariates were demographic or socioeconomic variables, medical conditions and functional status.


RESULTS
Prevalence of Pap smear use across the seven cities ranged from 21% in Bridgetown to 45% in Mexico City. In a multivariate analysis of the combined sample, without Havana that has universal health care insurance, women with public insurance (OR 0.55, 95% CI 0.43-0.71) or with no insurance (OR 0.23, 95% CI 0.15-0.34) were less likely to have a Pap smear compared with women with private insurance. Also, women with no insurance were less likely to have a Pap smear (OR 0.40, 95% CI 0.30-0.54) compared with women with any health insurance.


CONCLUSIONS
In general, the prevalence of Pap smear use was lower than that reported for Hispanic populations in the United States. Overall, lack of health insurance or having public health insurance determined lower odds for having a Pap smear for cervical cancer screening.
Sealy Center on Aging, Division of Geriatrics, University of Texas Medical Branch, Galveston, TX77555-0460, USA. careyeso@utmb.edu
Carlos A
CA
Reyes-Ortiz
Luis F
LF
Velez
Maria E
ME
Camacho
Kenneth J
KJ
Ottenbacher
Kyriakos S
KS
Markides
D000368:Aged; D017691:Caribbean Region; D002947:Cities; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D007843:Latin America; D016015:Logistic Models; D008875:Middle Aged; D065006:Papanicolaou Test; D010342:Patient Acceptance of Health Care; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D016387:Women's Health