Abstract A120: Disparities in cervical cancer screening rates and electronic health record completeness among All of Us Research Program participants
Authors: Tesfaye Samantha , Litwin Tamara , Schully Sheri 
Published: January 2023

Abstract
With the introduction of the Papanicolaou and HPV tests, cervical cancer rates have been reduced by up to 70% in the United States since the 1950s. In 2018, overall incidence was 8.0/100,000 and mortality was 2.0/100,000. But despite the overall decline in rates, the burden of cervical cancer still impacts different populations unevenly. For example, Black women in Louisiana had a cervical cancer death rate more than twice the national average at 4.6/100,000, which can in part be attributed to disparities in cervical cancer screening rates. The All of Us Research Program (AoU) is a nationwide longitudinal study that seeks to accelerate health research and medical breakthroughs by engaging people and communities who have historically been left out of medical research. The AoU dataset was used to determine if cervical cancer screening rates among participants reflect national rates, both overall and for specific demographics. We also aimed to identify and quantify disparities in electronic health record (EHR) completeness among AoU participants. Participants who were assigned female at birth, between the ages of 21 and 65, and with an intact cervix were considered eligible for screening. From the eligible population, those that had any EHR were identified using body height, heart rate, and body weight as proxies. Univariate and multivariate logistic regression were used to determine the likelihood of having record of up-to-date screening and the likelihood of having any EHR with the following covariates: age, race/ethnicity, gender identity, sexual orientation, income level, educational attainment, insurance status, geography, region, disability status, HIV status, and EHR site. A total of 144,541 participants were found to be eligible for screening. Of these, 118,576 had any EHR and 20,332 showed a history of screening. Sixty-seven percent of participants with screening history were up to date according to the U.S. Preventative Services Task Force guidelines. Age, race/ethnicity, region, insurance status, and HIV status were associated with up-to-date screening records. Black and Hispanic participants (0.65, p&lt;0.001 and 0.85, p =0.002 respectively), Midwestern participants (0.45, p&lt;0.001), uninsured participants (0.79, p=0.007), and participants living with HIV (0.44, p&lt;0.001) were less likely to have up-to-date screening compared to White participants, Northeastern participants, insured participants, and participants without HIV. Participants were less likely to have up-to-date screening as age increased, where participants ages 60-65 were least likely (0.21, p&lt;0.001) to have up-to-date screening compared to ages 21-29. Educational attainment, income level, sexual orientation, gender identity, disability status, and geography were not associated with up-to-date screening records. There is a high rate of data missingness for cervical cancer screening in the AoU dataset. However, overall trends in screening rates among AoU participants likely reflect true health disparities. Some observed trends may be due to AoU’s unique population.
Citation Format: Samantha Tesfaye, Tamara Litwin, Sheri Schully. Disparities in cervical cancer screening rates and electronic health record completeness among All of Us Research Program participants [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A120.