Breast and Cervical Cancer Screening: Impact of Health Insurance Status, Ethnicity, and Nativity of Latinas

Michael A. Rodríguez; Lisa M. Ward; Eliseo J. Pérez-Stable

doi:10.1370/afm.291

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Table 1.

Sociodemographic Characteristics of Women, Aged 18 Years and Older, by Ethnicity and Nativity Status, 1998 (N = 3,340)

Characteristics	Foreign-Born Latinas % (n)	US-Born Latinas % (n)	Non-Latina Whites % (n)
Note: Data derived from the 1998 California Women’s Health Survey, weighted to make respondents statistically representative of all women in California according to age and race in accordance with the 1990 California population.
NA = not applicable.
* χ² tests determined differences were significant, P ≤ .01 for each characteristic.
† Proportions in each age group do not equal 100% due to rounding.
Age, y
18–39	64 (328)	65 (223)^†	44 (1,105)
40–59	26 (131)	20 (70)	30 (736)
≥ 60	10 (51)	14 (49)	26 (648)
Income level*
≤ 100% poverty	56 (250)	29 (93)	10 (223)
101%–200% poverty	29 (129)	21 (66)	19 (432)
>200% poverty	15 (66)	50 (159)	71 (1,620)
Educational level*
<High school	62 (317)	21 (71)	8 (193)
Completed high school	18 (92)	31 (106)	26 (645)
>High school	20 (100)	48 (164)	66 (1,651)
Employment, full-time	32 (163)	38 (130)	35 (883)
Insurance status,* uninsured	44 (213)	19 (57)	10 (198)
Current marital status, married	56 (286)	45 (154)	53 (1,325)
Birth in the last 3 years*	30 (120)	29 (72)	20 (274)
Spanish language interview*	76 (386)	5 (16)	N/A
Total, n	510	341	2,489

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Table 2.

Proportion of Women Receiving Papanicolaou Test, Mammography, and Clinical Breast Examination, by Ethnicity, 1998 (N = 3,340)

Cancer Screening Examination	Foreign-Born Latina % (n)	US-Born Latina % (n)	Non-Latina Whites % (n)
Note: Data derived from the 1998 California Women’s Health Survey weighted to make respondents statistically representative of all women in California according to age and race in accordance with the 1990 California population. Percentages may not total 100% due to missing responses.
* P values for utilization rates between ethnic and nativity groups are significant, P <.01.
† Foreign born Latina vs non-Latina White.
‡ Foreign born Latina vs US-born Latina, P <0.05.
§ US-born vs non-Latina White
\|\| Foreign-born Latina vs US-born Latina.
Mammography
Recently screened (within 2 y)¹	66 (147)^†	75 (119)	78 (1168)
Never screened¹	21 (48)^†‡	12 (20)	9 (132)
Clinical breast examination
Recently screened (within 2 y)¹	66 (148)^†	73 (117)^§	82 (1235)
Never screened¹	24 (53)^†\|\|	11 (18)^§	5 (69)
Papanicolaou smear
Recently screened (within 3 y)	85 (559)	85 (378)	85 (2021)
Never screened¹	9 (59)^†	7 (29)^§	2 (63)

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Table 3.

Adjusted Odds Ratios of the Association Between Explanatory Variables and Lack of Recent Papanicolaou Smear, Mammography, and Clinical Breast Examination (N = 3,340)

	Mammography Examination in Previous 2 Years		Clinical Breast Examination in Previous 2 Years		Papanicolaou Smear in Previous 3 Years
Variable	Adjusted OR	95% CI	Adjusted OR	95% CI	Adjusted OR	95% CI
Note: Data derived from the 1998 California Women’s Health Survey weighted to make respondents statistically representative of all women in California according to age and race in accordance with the 1990 California population. Papanicolaou data include all women, whereas mammography and clinical breast examination data include women ≥ 40 years of age.
OR = odds ratio; CI = confidence interval.
* Models are adjusted for age in 5-year intervals, birthplace/ethnicity (US white as referent vs Latina-foreign and Latina US), poverty level (≤ 200% vs >200%), education (more vs less than high school graduate), employment (not full-time vs full-time), insurance (any insurance vs none), marital status (married vs not married), and giving birth (in the last 3 years vs not).
Foreign-born Latina²	0.60	0.45–0.81	1.19	0.90–1.56	0.59	0.41–0.84
US-born Latina	0.91	0.69–1.20	1.38	1.06–1.81	1.11	0.80–1.54
Uninsured*	2.05	1.53–2.76	2.29	1.80–2.90	2.89	2.17–3.85
Less than high school education	1.20	0.89–1.61	1.49	1.16–1.92	1.37	1.01–1.86
≤ 200% poverty*	1.69	1.33–2.14	2.12	1.71–2.64	1.58	1.23–2.03
Employment full-time	0.79	0.65–0.95	0.66	0.54–0.81	0.66	0.52–0.84
Age 5 y*	0.90	0.89–0.91	1.00	0.99–1.01	1.02	1.02–1.03
Unmarried*	1.35	1.11–1.63	1.39	1.16–1.68	1.39	1.12–1.72
Childbirth in last 3 y*	–	–	–	–	0.30	0.20–0.45

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The Article in Brief

Background: Latinas in the United States are more likely than non-Latinas to be diagnosed with later-stage breast cancer and have worse breast cancer survival results. The rate of cervical cancer in Latinas is twice that of non-Latina whites. This study examined the relationship between health insurance coverage and rates at which cancer screening was used by foreign-born and U.S.-born Latinas compared to non-Latina whites.
What This Study Found: Foreign-born Latinas have higher rates of never being screened with a mammogram, a clinical breast exam, and a Pap smear, compared with U.S.-born Latinas and non-Latina whites. Among all ethnic and native groups studied, timely screening for breast cancer and cervical cancer is 11% to 48% lower for uninsured women. A greater proportion of foreign-born Latinas are uninsured compared with other groups studied, so they are at greater risk of not receiving timely cancer screening.
Implications:
* Foreign-born Latinas might benefit from tailored public health efforts to improve the use of cancer screening services.
* Programs that are culturally and linguistically appropriate and that take into account whether participants are foreign-born or U.S. born could help reduce health differences based on ethnicity.
* Lack of health insurance is a significant obstacle that needs to be addressed to improve use of cancer screening services for all uninsured women.