title: Spatial variations in cervical cancer prevention in Colombia: Geographical differences and associated socio-demographic factors.
abstract: We examined spatial variations in the frequencies of women who had not heard of human papillomavirus vaccination (NHrd-Vac) and who had not had Pap testing (NHd-Pap) among Colombian administrative divisions (departments), before and after considering differences in socio-demographic factors. Following global and local tests for clustering, Bayesian Poisson hierarchical models identified department factors associated with NHrd-Vac and NHd-Pap, as well as the extent of the spatially structured and unstructured heterogeneity. Models of spatial variations for both outcomes included the department percentage of women with subsidised health insurance. The relative risks of NHrd-Vac and NHd-Pap were highest in several departments adjacent to the Colombian border. Our finding that the risk of not having adequate access to cervical cancer (CC) prevention programmes in Colombia was location-dependent, could be used to focus resources for CC prevention programmes.
authors.affiliation: School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon SK S7N 5E5, Canada. Electronic address: silvia.bermedo@usask.ca.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bermedo-Carrasco
authors.affiliation: Western College of Veterinary Medicine and School of Public Health, University of Saskatchewan, 52 Campus Drive Saskatoon SK S7N 5B4, Canada. Electronic address: cheryl.waldner@usask.ca.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Waldner
authors.affiliation: College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon SK S7N 0W8, Canada. Electronic address: juan.nicolas.ps@usask.ca.
authors.forename: Juan Nicolás
authors.initials: JN
authors.lastname: Peña-Sánchez
authors.affiliation: School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon SK S7N 5E5, Canada. Electronic address: michael.szafron@usask.ca.
authors.forename: Michael
authors.initials: M
authors.lastname: Szafron
mesh_terms: D000293:Adolescent; D000328:Adult; D003105:Colombia / Q000453:epidemiology; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test / Q000706:statistics & numerical data; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D012959:Socioeconomic Factors; D062211:Spatio-Temporal Analysis; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D014932:Women's Health Services / Q000706:statistics & numerical data*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control
keywords: Bayesian analysis; Cervical cancer prevention; Colombia; Pap test; Papillomavirus vaccines; Spatial analysis