title: [How does type of health insurance affect receipt of Pap testing in Peru?].
abstract: OBJECTIVE
  Describe the association between receipt of cervical cytology and type of health insurance in Peruvian women, and determine the role of sociodemographic and sexual health variables in this relationship.
  
  
  METHODS
  A cross-sectional study using information on a sample of 12 272 women aged 30 to 49 years from the Demographic and Family Health Survey (ENDES), Peru, 2005-2008. The dependent variable was receipt of at least one Pap smear in the last five years. The primary independent variables were type of health insurance, educational level, household socioeconomic level, ethnicity, and place of residence. Prevalence ratio, obtained from Poisson regression with robust variance, was used to measure multivariate association.
  
  
  RESULTS
  Among sexually active women, 62.7% had received at least one Pap test in the last five years. Percentage of women tested varied by type of health insurance. Women with public or private insurance had a greater probability of having received a Pap smear--1.27 (95% CI, 1.24-1.31) and 1.52 (95% CI, 1.46-1.58) times greater, respectively--than uninsured women. This association was primarily explained by socioeconomic status variables. In addition, women who participated the least in screening were characterized by illiteracy or only a primary education, low socioeconomic level, speaking an indigenous language, and living in a rural area. When they also lacked health insurance, the gap widened, rising to as much as one third compared to more advantaged social groups.
  
  
  CONCLUSIONS
  Inequalities were found in receipt of Pap testing according to type of health insurance; women without insurance were least likely to be screened, implying existence of a barrier to cervical cancer screening in Peru.
authors.affiliation: Institut Català d'Oncologia, Barcelona, España, lesliebarrio@gmail.com.
authors.forename: Leslie
authors.initials: L
authors.lastname: Barrionuevo-Rosas
authors.affiliation: Ciber de Epidemiología y Salud Pública, Madrid, España.
authors.forename: Laia
authors.initials: L
authors.lastname: Palència
authors.affiliation: Agència de Salut Pública de Barcelona, Barcelona, España.
authors.forename: Carme
authors.initials: C
authors.lastname: Borrell
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D004522:Educational Status; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D054624:Health Status Disparities; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health / Q000145:classification / Q000706:statistics & numerical data; D017057:Medically Uninsured; D008875:Middle Aged; D065006:Papanicolaou Test / Q000191:economics / Q000706:statistics & numerical data*; D010568:Peru; D015995:Prevalence; D012307:Risk Factors; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D012959:Socioeconomic Factors; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000517:prevention & control