Abstract
Cervical cancer screening detects cancer at early stages and
is available to Ontario women ages 21 to 69 years of age. Notwithstanding
cancer screening initiatives, sub-groups of Ontario women are under-screened
based on current literature. The most
common primary health care delivery system in Ontario are patient enrolment
models (PEMs) which allows for physician-incentives when rostering and cancer
screening benchmarks are met. Notwithstanding, little is known about the effect
of PEM enrolment and other socioeconomic (SES) factors, such as income, on
screening uptake. This study considered differences in cervical screening
uptake by PEM status and neighbourhood income levels by women residing in the
Central East Local Health Integration Network (CELHIN).
A descriptive, comparative study using record level,
administrative data from Cancer Care Ontario of eligible CELHIN women between
January 1, 2012 and June 30, 2015 was conducted (N=490, 574). The variables of
interest were cervical screening uptake (dependent variable), PEM status
(primary exposure variable), neighbourhood income quintile (independent
variable) and controlled for age and rurality.
Using logistic regression, it was determined non-enrolled
women were more likely not to be screened (OR =6.98, 95% CI, 6.87-7.08)
compared to enrolled women, representing the strongest association. Given heterogeneous effects in odds ratios,
multivariate stratified logistic regression analyses were undertaken for PEM
enrolled and non-enrolled women separately. A significant association was found
between older, non-enrolled women (ages 60-69) and not being screened (OR=1.87,
95% CI, 1.78-1.96). Unexpectedly, enrolled women in the lowest neighbourhood
income quintile were more likely to not be screened (OR=1.49, 95% CI,
1.46-1.53) compared to their non-enrolled counterparts (OR=1.20, 95% CI,
1.14-1.25). Urban dwellers were slightly
less likely to be screened (enrolled women: OR=1.10, 95% CI, 1.07-1.12;
non-enrolled women, OR=1.06, 95% CI 1.01-1.11) relative to rural women.
As older women have the greatest risk of high-grade invasive
cervical cancer and PEM status is not protective for women living in lower SES,
the priority for the CELHIN should be addressing barriers to cervical screening
uptake, regardless of PEM status, for marginalized at-risk women including
older women, and women living in lower SES environments.