Abstract B007: Racial/ethnic and socioeconomic disparities in over- and under-screening of cervical cancer among a national sample of commercially insured individuals
Authors: Shin Michelle B. , Axeen Sarah , Tsui Jennifer 
Published: September 2024

In the United States (US), disparities in cervical cancer screening uptake persist by race/ethnicity and socioeconomic status (SES). However, few have examined how race/ethnicity and SES contribute to specific guideline adherence patterns, which can exacerbate existing disparities. We investigated the impact of race/ethnicity and SES (education and household net worth [HHN]) on the probability of over- and under-screening. Optum Clinformatics Data Mart from 2012-2021 was used to identify average-risk females aged 30-64 and ≥1 cervical cancer screening with continuous health plan enrollment and no history of hysterectomy/cervical cancer. Over- and under-screening were defined as intervals between the index and subsequent screening which were shorter and longer than the interval recommended by the 2012 US Preventive Services Task Force guideline, respectively. Multivariate logistic regression was used to evaluate the association of race/ethnicity (Non-Hispanic [NH]-White, NH-Asian, Hispanic, NH-Black) and SES including HHN (&lt;$250,000, $250,000-$500,000, &gt;$500,000) and education level (&lt;Bachelor’s Degree, &gt;Bachelor’s Degree) with over- and under-screening. We tested for interactions between race/ethnicity and SES. Of the 686,884 eligible patients, 72.8% were NH-White, 71.4% had &lt;Bachelor's Degree and 43.3% had HHN &lt;$250,000. Only 7.2% were guideline adherent, 30.7% were under-screened, and 62.1% were over-screened. After regression adjustment, the odds of under-screening were higher among NH-Asian (OR, 1.2; 95%CI, 1.1- 1.2), NH-Black (OR, 1.1; 95%CI, 1.0-1.1), and Hispanic (OR, 1.2; 95%CI, 1.1-1.2) vs NH-White, &lt;Bachelor’s degree (OR, 1.1; 95%CI, 1.0-1.1) vs &gt;Bachelor’s degree, and HHN &lt;$250,000 (OR, 1.3 95%CI, 1.2-1.3) and $250,000-$499,000 (OR, 1.1; 95%CI, 1.0-1.1) vs &gt;$500,000. Odds of over-screening were higher among NH-Black (OR, 1.3; 95%CI, 1.2-1.3), and Hispanic (OR, 1.2; 95%CI, 1.1-1.2) vs NH-White, and lower among &lt;Bachelor’s degree (OR, 0.9; 95%CI, 0.8-0.9) vs &gt;Bachelor’s degree, and HHN &lt;$250,000 (OR, 0.9; 95%CI, 0.9-1.0) and $250,000-$499,000 (OR, 0.9; 95%CI, 0.9-1.0) vs &gt;$500,000. For under-screening, the interaction between race/ethnicity and HHN was significant, and the predicted probability (PP) increased with higher HHN among Hispanic but not in other groups (p&lt;0.01). For over-screening, the interaction between race/ethnicity and HHN was significant and the PP increased with higher HHN among Hispanic and NH-White but decreased for NH-Black and NH-Asian. The interaction between race/ethnicity and education was significant and the PP increased with higher education among Hispanic and NH-White but decreased among NH-Black and NH-Asian. Even within a commercially insured population, we observed that the majority of patients received non-guideline adherent screening and SES contributed to disparities differently among racial/ethnic groups. Findings indicate the need to tailor interventions and policies for subpopulations experiencing over- and under-screening to address the overall screening quality and disparities in outcomes.

Citation Format: Michelle B. Shin, Sarah Axeen, Jennifer Tsui. Racial/ethnic and socioeconomic disparities in over- and under-screening of cervical cancer among a national sample of commercially insured individuals [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B007.