title: The first comprehensive report on Indigenous Australian women's inequalities in cervical screening: A retrospective registry cohort study in Queensland, Australia (2000-2011).
abstract: The Australian National Cervical Screening Program, introduced more than 20 years ago, does not record the Indigenous status of screening participants. This article reports the first population-based estimates of participation in cervical screening for Indigenous and non-Indigenous Australian women.
  
  
  
  This was a retrospective, population-based study of 1,334,795 female Queensland residents, aged 20 to 69 years, who participated in cervical screening from 2000 to 2011; 26,829 were identified as Indigenous through linkage to hospitalization records. Participation rates were calculated as the number of women screened divided by the average estimated resident population, with adjustments made for hysterectomies, for each 2-, 3-, and 5-year screening period. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), which were adjusted for age group, place of residence, and socioeconomic disadvantage.
  
  
  
  In 2010-2011, the 2-year participation rate was 55.7% (95% CI, 55.6%-55.9%) for non-Indigenous women and 33.5% (95% CI, 32.9%-34.1%) for Indigenous women; this represented a decrease from 2000-2001 (57.7% [95% CI, 57.6%-57.9%] and 35.3% [95% CI, 34.5%-36.1%], respectively). The difference between Indigenous and non-Indigenous women was greatest for those aged 45 to 49 years. The 3- and 5-year participation rates were higher within both groups, and the absolute differences between the 2 groups were larger. Significant interactions between the Indigenous status and the place of residence and socioeconomic disadvantage highlight that the Indigenous/non-Indigenous differential was evident in all places of residence except for very remote areas (OR, 0.99; 95% CI, 0.95-1.02) and was greatest in the most affluent areas (OR, 0.26; 95% CI, 0.24-0.27).
  
  
  
  Indigenous Australian women participate less than non-Indigenous women, and this gap has not closed. These results provide important benchmarks for the new Australian cervical screening program commencing in 2017, which will provide opportunities to reduce inequities for Indigenous women and address longstanding data deficiencies in the collection of the Indigenous status. Cancer 2016;122:1560-9. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Whop
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
authors.forename: Gail
authors.initials: G
authors.lastname: Garvey
authors.affiliation: Cancer Council Queensland, Brisbane, Queensland, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Baade
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
authors.forename: Joan
authors.initials: J
authors.lastname: Cunningham
authors.affiliation: Australian National University, Canberra, Australian Capital Territory, Australia.
authors.forename: Kamalini
authors.initials: K
authors.lastname: Lokuge
authors.affiliation: Victorian Cytology Service, Melbourne, Victoria, Australia.|School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Julia M L
authors.initials: JM
authors.lastname: Brotherton
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.|QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Valery
authors.affiliation: Cancer Council New South Wales, Sydney, New South Wales, Australia.|School of Public Health, Sydney Medical School, University of Sydney, New South Wales, Sydney, Australia.|School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Dianne L
authors.initials: DL
authors.lastname: O'Connell
authors.affiliation: Cancer Council New South Wales, Sydney, New South Wales, Australia.|School of Public Health, Sydney Medical School, University of Sydney, New South Wales, Sydney, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Canfell
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
authors.forename: Abbey
authors.initials: A
authors.lastname: Diaz
authors.affiliation: Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Roder
authors.affiliation: Victorian Cytology Service, Melbourne, Victoria, Australia.
authors.forename: Dorota
authors.initials: D
authors.lastname: Gertig
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
authors.forename: Suzanne P
authors.initials: SP
authors.lastname: Moore
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
authors.forename: John R
authors.initials: JR
authors.lastname: Condon
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011793:Queensland; D012042:Registries; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Indigenous Australian; Papanicolaou (Pap) test; cancer; cervical screening; early detection; health care disparities