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1 Department of Family Medicine at the David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif
2 Department of Obstetrics and Gynecology, Center for Women’s Health, University of California, Davis, Sacramento, Calif
3 Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, Center for Aging in Diverse Communities, Comprehensive Cancer Center, University of California, San Francisco, San Francisco, Calif
CORRESPONDING AUTHOR: Michael A. Rodríguez, MD, David Geffen School of Medicine at UCLA, Oppenheimer Tower, Suite 1800, 10880 Wilshire Blvd, Los Angeles, CA 90024, mrodriguez{at}mednet.ucla.edu
PURPOSE Although rates of cancer screening for Latinas are lower than for non-Latina whites, little is known about how insurance status, ethnicity, and nativity interact to influence these disparities. Using a large statewide database, our study examined the relationship between breast and cervical cancer screening rates and socioeconomic and health insurance status among foreign-born Latinas, US-born Latinas, and non-Latina whites in California.
METHODS Data from the1998 California Women’s Health Survey (CWHS) were analyzed (n = 3,340) using multiple logistic regression models. Utilization rates of mammography, clinical breast examinations, and Papanicolaou (Pap) smear screening among foreign-born Latinas, US-born Latinas, and non-Latina whites were the outcome measures.
RESULTS Foreign-born Latinas had the highest rates of never receiving mammography, clinical breast examinations, and Pap smears (21%, 24%, 9%, respectively) compared with US-born Latinas (12%, 11%, 7%, respectively) and non-Latina whites (9%, 5%, 2%, respectively). After controlling for socioeconomic factors, foreign-born Latinas were more likely to report mammography use in the previous 2 years and Pap smear in the previous 3 years than non-Latina whites. Lack of health insurance coverage was the strongest independent predictor of low utilization rates for mammography (odds ratio [OR] = 2.05; 95% confidence interval [CI], 1.53–2.76), clinical breast examinations (OR = 2.29; 95% CI, 1.80–2.90) and Pap smears (OR = 2.89; 95% CI, 2.17–3.85.)
CONCLUSIONS Breast and cervical cancer screening rates vary by ethnicity and nativity, with foreign-born Latinas experiencing the highest rates of never being screened. After accounting for socioeconomic factors, differences by ethnicity and nativity are reversed or eliminated. Lack of health insurance coverage remains the strongest predictor of cancer screening underutilization.
Key Words: Breast neoplasms • cervix neoplasms • prevention & control • Hispanic Americans • delivery of health care • minority groups
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