Adherence and Correlates of Cervical Cancer Screening Among East African Immigrant Women in Washington State.

ABSTRACT

INTRODUCTION: Cervical cancer screening (CCS) among East African immigrants (EAI) in the USA is under explored. This study aimed to investigate adherence to CCS and its correlates among EAI. METHODS: We identified 1664 EAI women (25-65 years) with ≥ 1 primary care clinic visit(s) between 2017 and 2018, using University of Washington (UW) Medicine electronic health record data. CCS adherence was defined as Pap testing within 3 years or human papillomavirus/Pap co-testing within 5 years. We used Poisson regression with robust standard errors to cross-sectionally estimate associations with correlates of adherence. Twelve-month screening uptake was also evaluated among overdue women. RESULTS: CCS adherence was 63%. Factors associated with higher adherence included older age (adjusted prevalence ratios [APRs]1.4795%CI1.14-1.90, 1.3895%CI1.05-1.80, respectively, for ages 30-39 and 40-49 vs 25-29 years), longer duration of care at UW Medicine (APR1.2295%CI1.03-1.45, comparing > 10 vs < 5 years), higher visit frequency (APR1.2395%CI1.04-1.44, 1.4695%CI1.24-1.72, respectively, for 3-5 and ≥ 6 vs 1-2 visits), index visit in an obstetrics-gynecology clinic (APR1.2695%CI1.03-1.55, vs family practice), having an assigned primary care provider (APR1.35 95%CI1.02-1.79), breast cancer screening adherence (APR1.66 95%CI1.27-2.17), and colorectal cancer screening adherence (APR1.5995%CI1.24-2.03). Low BMI was associated with lower adherence (APR0.5095%CI0.26-0.96, comparing < 18.5 kg/m2 vs 18.5-24.9 kg/m2). Among 608 (37%) overdue women, 9% were screened in the subsequent 12 months. Having commercial health insurance vs Medicare/Medicaid was associated with higher uptake (adjusted risk ratio2.4495%CI1.15-5.18). CONCLUSION: CCS adherence among EAI was lower than the national average of 80%. Interventions focused on increasing healthcare access/utilization or leveraging healthcare encounters to address barriers could increase CCS in EAIs.