title: Contribution of health care coverage in cervical cancer screening follow-up: findings from a cross-sectional study in Colombia.
abstract: OBJECTIVE
  To determine the role of health care coverage (HCC) in follow-up of cervical cancer screening (seeking Papanicolaou test results and follow-up when abnormal results were found) among Colombian women.
  
  
  METHODS
  A population-based cross-sectional study of 24,717 women, using the 2005 Colombian Demographic and Health Survey, was conducted.
  
  
  RESULTS
  Nearly 4% of women screened did not seek their results. For approximately 17% of the women, there was no follow-up when abnormal results were found. Women in the contributory regime (private insurance) and those in the subsidized regime (public insurance) were more likely to seek Papanicolaou test results than women without HCC, even after adjusting for sociodemographic factors (adjusted odds ratio [ORa], 1.96; 95% confidence interval [CI], 1.60-2.41 and ORa, 1.34; 95% CI, 1.14-1.58, respectively). For follow-up when abnormal results were found, there was no difference between the subsidized regime and no HCC, but women in the contributory regime were more likely to follow-up than women without HCC (ORa, 1.40; 95% CI, 1.05-1.86).
  
  
  CONCLUSIONS
  Seeking Papanicolaou test results is relatively high among Colombian women; however, there are differences according to HCC. Follow-up when abnormal Papanicolaou test results were found was positively associated only with private insurance; follow-up is the same for women without insurance and with public insurance. Exploring strategies to promote follow-up among women and to improve cervical cancer follow-up services for those enrolled in the subsidized regime may increase follow-up rates among Colombian women.
authors.affiliation: Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. isabel.garcespalacio@fulbrightmail.org
authors.forename: Isabel C
authors.initials: IC
authors.lastname: Garcés-Palacio
authors.forename: Maja
authors.initials: M
authors.lastname: Altarac
authors.forename: Russell
authors.initials: R
authors.lastname: Kirby
authors.forename: Leslie A
authors.initials: LA
authors.lastname: McClure
authors.forename: Beverly
authors.initials: B
authors.lastname: Mulvihill
authors.forename: Isabel C
authors.initials: IC
authors.lastname: Scarinci
mesh_terms: D000293:Adolescent; D000328:Adult; D003105:Colombia / Q000453:epidemiology; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019458:Insurance Coverage; D008875:Middle Aged; D065006:Papanicolaou Test; D011379:Prognosis; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D014626:Vaginal Smears; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control