title: Sociodemographic factors associated with cervical cancer screening and follow-up of abnormal results.
abstract: OBJECTIVE
  To determine the sociodemographic factors associated with cervical cancer screening and follow-up of abnormal results.
  
  
  METHODS
  Population cohort study.
  
  
  METHODS
  Ontario.
  
  
  METHODS
  Women between the ages of 18 and 70 years who were eligible for Papanicolaou testing.
  
  
  METHODS
  Rates of cervical cancer screening and follow-up of abnormal and inadequate Pap test results, and associated sociodemographic factors such as age, neighbourhood income level, and health region. Multivariate logistic regression was used to identify independent factors associated with screening and follow-up.
  
  
  RESULTS
  Of the 3.7 million women eligible for screening, 69% had had Pap tests in the past 3 years. These rates varied by age, income, and region (P < .001). Women residing in the lowest-income neighbourhoods were half as likely to be screened (odds ratio 0.56, 95% CI 0.55 to 0.56). Only 44% of those whose Pap test results revealed atypical squamous cells of uncertain significance or low-grade squamous intraepithelial lesions had repeat Pap tests or colposcopy within 6 months, and this varied by age, income, and region (P < .001). Among women with unsatisfactory Pap test results, only 35% were retested within 4 months, and this varied by age (P < .001).
  
  
  CONCLUSIONS
  Despite universal health coverage, cervical cancer screening rates are suboptimal among low-income women at greatest risk. Follow-up among women with inadequate or abnormal test results is often poor. Novel models of cervical cancer screening are needed to address these inadequacies.
authors.affiliation: Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ont, Canada. laurie.elit@jcc.hhsc.ca
authors.forename: Laurie
authors.initials: L
authors.lastname: Elit
authors.forename: Monika
authors.initials: M
authors.lastname: Krzyzanowska
authors.forename: Refik
authors.initials: R
authors.lastname: Saskin
authors.forename: Lisa
authors.initials: L
authors.lastname: Barbera
authors.forename: Asma
authors.initials: A
authors.lastname: Razzaq
authors.forename: Aisha
authors.initials: A
authors.lastname: Lofters
authors.forename: Naira
authors.initials: N
authors.lastname: Yeritsyan
authors.forename: Arlene
authors.initials: A
authors.lastname: Bierman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada; D015331:Cohort Studies; D003127:Colposcopy; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D065006:Papanicolaou Test; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D055815:Young Adult