title: The role of socio-demographic factors in premature cervical cancer mortality in Colombia.
abstract: While cervical cancer (CC) is an important cause of premature mortality in Colombia, the impact of socio-demographic factors on CC mortality in young women is not well understood. The primary objective of this study was to identify differences in CC mortality among Colombian women aged 20-49 years associated with education, type of health insurance, urban or rural and region of residence, and to determine whether differences in mortality associated with education or insurance varied by age.
  
  
  
  Cervical cancer deaths for 2005-2013 and risk factors were obtained from the National Administrative Department of Statistics. Populations at risk were calculated from age-stratified population projections and the 2010 National and Demographic Health Survey. Negative binomial regression models, stratified by age, were used to examine associations between socio-demographic factors and mortality rates and whether the effects of education and health insurance varied by age. Multiple imputation was used to examine the importance of missing data.
  
  
  
  Differences of CC mortality were identified among women with limited to no education compared to highly educated women, with the largest disparity in the youngest age group (IRR 26.8, 95 % CI 6.65-108). Differences in mortality associated with health insurance also varied based on age group. Women with contributory and special health insurance had lower mortality rates than women with subsidised or no health insurance, except in the youngest age group. No differences were observed between women with subsidised and those with no insurance in any age group. Mortality rates were high among women who resided in urban areas and in the Atlantic, Central, Pacific, and Amazon-Orinoquía regions of Colombia. Missing values in the mortality database did not impact the findings from this study.
  
  
  
  Limited education was most strongly associated with premature CC mortality in the youngest women. Subsidised insurance did not appear to provide significant protection against CC mortality when compared to not having insurance, suggesting the need to examine diagnostic and treatment services available under the subsidised insurance plan. Our results could be used to target interventions to optimise the impact of resources to prevent premature mortality due to CC in Colombia.
authors.affiliation: School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 5E5, Canada. silvia.bermedo@usask.ca.
authors.forename: Silvia
authors.identifier: 0000-0002-0001-6673
authors.initials: S
authors.lastname: Bermedo-Carrasco
authors.affiliation: Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, S7N 5B4, Canada.
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Waldner
mesh_terms: D000328:Adult; D000367:Age Factors; D003105:Colombia / Q000453:epidemiology; D003710:Demography; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008875:Middle Aged; D061213:Mortality, Premature; D012044:Regression Analysis; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data; D002583:Uterine Cervical Neoplasms / Q000401:mortality*; D055815:Young Adult
keywords: Colombia; Inequities; Mortality; Socioeconomic factors; Uterine cervical neoplasms