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IJE Advance Access published online on May 29, 2008
International Journal of Epidemiology, doi:10.1093/ije/dyn096
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2008; all rights reserved.

Health insurance and cervical cancer screening among older women in Latin American and Caribbean cities

Carlos A Reyes-Ortiz1,2,*, Luis F Velez3, Maria E Camacho1, Kenneth J Ottenbacher1,2 and Kyriakos S Markides1,4

1Sealy Center on Aging, Division of Geriatrics, University of Texas Medical Branch, Galveston, TX, USA.
2Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA.
3Department of Epidemiology and Biostatistics, Institute for Health Promotion Research, School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
4Department of Preventive Medicine & Community Health, University of Texas Medical Branch, Galveston, TX, USA.

*Corresponding author. Sealy Center on Aging, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0460, USA. E-mail: careyeso{at}utmb.edu; careyesortiz{at}hotmail.com


  Abstract

Background The purpose of this study is to describe the prevalence of Papanicolaou (Pap) smear use for cervical cancer screening and to estimate its association with type of health care insurance.

Methods A cross-sectional study using data from the Health, Well-Being and Aging in Latin America and the Caribbean Study (SABE). The sample includes 6357 women aged 60 and older from seven cities. The outcome was reporting a Pap smear for cervical cancer screening during the previous 2 years. Main independent variable was health care insurance. Covariates were demographic or socioeconomic variables, medical conditions and functional status.

Results Prevalence of Pap smear use across the seven cities ranged from 21% in Bridgetown to 45% in Mexico City. In a multivariate analysis of the combined sample, without Havana that has universal health care insurance, women with public insurance (OR 0.55, 95% CI 0.43–0.71) or with no insurance (OR 0.23, 95% CI 0.15–0.34) were less likely to have a Pap smear compared with women with private insurance. Also, women with no insurance were less likely to have a Pap smear (OR 0.40, 95% CI 0.30–0.54) compared with women with any health insurance.

Conclusions In general, the prevalence of Pap smear use was lower than that reported for Hispanic populations in the United States. Overall, lack of health insurance or having public health insurance determined lower odds for having a Pap smear for cervical cancer screening.

Keywords Older women, cancer screening, Latin America and Caribbean, health insurance, Pap smear

Accepted 1 May 2008


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