title: Suboptimal rates of cervical testing among women with inflammatory bowel disease.
abstract: OBJECTIVE
  Women with IBD have a high incidence of abnormal cervical cytology. However, little is known about how frequently women with IBD are tested for cervical abnormalities. We aimed to determine cervical testing rates among women with IBD, specifically those on immunosuppressant medications, and to identify risk factors associated with low incidence of screening.
  
  
  METHODS
  With the PharMetrics Patient-Centric Database from 1996-2005, we identified cases of IBD and matched controls via a validated algorithm. With logistic regression, we compared utilization of cervical testing with IBD case status, patients' age, use of immunosuppressive medications, Medicaid insurance status, and use of primary care services.
  
  
  RESULTS
  Only 70.4% of women with IBD (n = 9356) and 65.2% of matched controls (n = 25,849) received cervical testing (at least once every 3 years). Women with IBD who used primary care services had increased odds of cervical testing (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.19-1.59). Factors associated with reduced testing included Medicaid insurance (OR, 0.28; 95% CI, 0.19-0.41), immunosuppressant medication use (OR, 0.81; 95% CI, 0.74-0.88), and increased age (P for trend < .01). Among women on immunosuppressive medications (n = 7415), 50.1% were tested during a 15-month period. Women on immunosuppressive medications who used primary care services have improved odds of cervical testing (OR, 1.28; 95% CI, 1.14-1.45), whereas those with Medicaid insurance had reduced odds (OR, 0.54; 95% CI, 0.39-0.74).
  
  
  CONCLUSIONS
  Women with IBD are tested for cervical abnormalities at suboptimal rates. Quality improvement initiatives are needed to improve disease prevention services for women with IBD.
authors.affiliation: Division of Gastroenterology and Hepatology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina 27599-7080, USA. longmd@email.unc.edu
authors.forename: Millie D
authors.initials: MD
authors.lastname: Long
authors.forename: Carol Q
authors.initials: CQ
authors.lastname: Porter
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sandler
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kappelman
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006302:Health Services Research; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy*; D008875:Middle Aged; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents