title: National trends and disparities in cervical cancer screening among commercially insured Women, 2001-2010.
abstract: BACKGROUND
  Previous surveys reported declining cervical cancer screening rates from 2000 to 2010, but trends by key demographic and age groups are less clear.
  
  
  METHODS
  We examined 3-year Papanicolaou (Pap) test rates among 4.2 million women enrolled in a large national health plan during 2001 to 2010. We calculated and plotted adjusted 3-year rates stratified by age and key neighborhood-level socioeconomic characteristics including poverty level and race/ethnicity (white, black, Hispanic, and mixed ethnicity neighborhood). We fitted trends in 2001-2010 screening rates and socioeconomic disparities as annual percentage changes (APC) using joinpoint analysis.
  
  
  RESULTS
  Women ages 21 to 29 years had estimated 3-year Pap testing rates of 81.3% to 81.4% over the decade. Estimated disparities by low-high poverty level were 3.1% and 2.0% in 2001-2003 and 2008-2010, respectively, a nonsignificant decline. Initial white-black disparities were 4.0% and declined significantly from 2005-2007 to 2008-2010 to 2.8% at an APC of -0.65% (P = 0.021). White-Hispanic disparities declined from 4.3% to 0.8% over the decade, a -0.50% APC (P = 0.024). Among women ages 30 to 64 years, estimated 3-year Pap testing rates trended down from 76.1% to 71.8% over the decade [-0.94% APC (P < 0.001) until 2005-2007]. This pattern was similar among women from most categories of poverty and race/ethnicity.
  
  
  CONCLUSIONS
  Among commercially insured women ages 21 to 29 years, 3-year Pap testing rates remained stable at 81% over the decade; disparities were small and improved for Hispanic women to a greater degree than for black women. Among women ages 30 to 64 years, 3-year Pap testing rates declined from 2001 to 2010.
  
  
  CONCLUSIONS
  Cervical cancer screening should be promoted to achieve Healthy People 2020 goals.
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts. jwharam@post.harvard.edu.
authors.forename: J Frank
authors.initials: JF
authors.lastname: Wharam
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
authors.forename: Xin
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D055088:Early Detection of Cancer / Q000639:trends*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D008875:Middle Aged; D065006:Papanicolaou Test / Q000639:trends*; D011203:Poverty; D012111:Residence Characteristics / Q000706:statistics & numerical data; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult