title: Socioeconomic disparities across ethnicities: an application to cervical cancer screening.
abstract: OBJECTIVE
  Our aim is to investigate socioeconomic disparities in cervical cancer screening utilization among and between ethnic groups in the United States.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Data on 26,338 women aged 21 to 64 years were obtained from the 2007 to 2011 years of the Medical Expenditure Panel Survey. Data on cervical cancer screening utilization in the preceding 12 months and 3 years, and a range of sociodemographic characteristics were included. Analyses were undertaken for all women and across racial/ethnic grouping (ie, white, black, Hispanic, and other). Concentration indices were used to measure the socioeconomic gradient across ethnic groups. Probit regression analyses were used to examine variations in utilization related to socioeconomic factors across ethnic groups controlling for a range of pertinent characteristics.
  
  
  RESULTS
  Annual utilization rates are high in the United States (60.15%) and greatest among black women (66.25%). Disparities, as measured by concentration indices (CIs), are large in the United States, with the largest being for white women (CI, 0.179) relative to black (CI, 0.103) and Hispanic (CI, 0.081) women. Screening differences across income, education and insurance status are also greater amongst white women.
  
  
  CONCLUSIONS
  Uptake of cervical cancer screening is common in the United States, with large socioeconomic disparities also evident. Those from lower socioeconomic or uninsured groups who are most likely to have, and to die from, cervical cancer, are least likely to use preventive screening. Disparities differ across ethnic groups and are greatest amongst white women. Incorporating organized screening may serve to improve both the systems efficiency and address disparities between and within groups.
authors.forename: Brendan
authors.initials: B
authors.lastname: Walsh
authors.affiliation: Cairnes School of Business, NUI Galway, University Rd, Galway, Ireland. E-mail: ciaran.oneill@nuigalway.ie.
authors.forename: Ciaran
authors.initials: C
authors.lastname: O'Neill
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D008875:Middle Aged; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D044465:White People / Q000706:statistics & numerical data