Social Determinants of Health Limit Preventive Care Access

According to researchers from the University of Texas Health Science Center at Houston, underserved populations were the most likely to have an overdue cervical cancer screening, underscoring social determinants of health (SDOH) impact on preventive care access.

The JAMA Network Open study explored the link between cervical cancer screening rates and sociodemographic factors, including age, race and ethnicity, sexual orientation, rurality of residence, and health insurance type.

Using data from the US National Health Interview Survey, researchers analyzed 20,557 women between the ages of 21 and 65.

Research revealed that the rate of women without a timely cervical cancer increased among all sociodemographic groups between 2015 and 2019, from 14.4 percent to 23.0 percent.  

Researchers noticed disparities in screening rates across age groups. For example, in 2019, nearly 29 percent of women between 21 and 29 years old were overdue for screening compared to women between 30 and 65. Only 21 percent over women age 30 to 65 were overdue.

The study findings showed that non-Hispanic White women had the lowest overdue cervical cancer screening rate. Conversely, in 2019, the highest rate of overdue screening was among Asian women.

Participants who lived in rural areas had a higher overdue screening rate than those in urban areas. Nearly 26 percent of participants that lived in rural areas were overdue for a screening versus 22.7 percent in urban areas.

In addition, insurance coverage impacted screening rates, with 47.1 percent of participants without insurance being overdue for screening versus 18.1 percent of participants with private insurance.

Those who identified as LGBQ+ had higher rates of overdue screening than those who identified as heterosexual.

Across all groups, the most reported reason for not receiving a timely screening was lack of knowledge. 

“The fact that this reason increased over time across most sociodemographic groups suggests a need for interventions targeting screening awareness for all women,” the researchers stated in the study.

While both Asian and Hispanic women reported a lack of knowledge as a barrier, limited health literacy about screening was more prevalent among Hispanic women. In comparison, White women were the least likely to state the same.

Meanwhile, the researchers said some women did not perceive a need for a cervical cancer screening. Women between age 21 and 29 were more likely than older women to say they didn’t get a screening because they didn’t think they needed one.

What’s more, some women told the researchers they simply did not have access to a cervical cancer screening. This trend was most common among non-Hispanic White women, while Hispanic women were twice as likely to report a lack of access as a barrier compared to Asian women. However, Asian women were more likely to report a lack of recommendation from a healthcare professional as a barrier.

Women with insurance were most likely to report a lack of recommendation as a barrier. Meanwhile, women without insurance reported not receiving screening because of lack of access nearly seven times more often than women with private insurance.

An estimated 56 percent of participants that identified as LGBQ+, reported lack of knowledge as a barrier. 

“When seeking to reduce disparities in cervical cancer outcomes, it will be important to design interventions that are flexible to targeted individuals’ needs, barriers, and facilitators. Although educational and practitioner-focused interventions may improve screening for many women, others may not benefit if access barriers are not addressed,” the researcher said.