Socio-demographic determinants of Pap coverage in Argentina: Results from the First National Survey on Risk Factors

ARROSSI, S., PAOLINO M.

Génova, Suiza

Congreso; 2008 World Cancer Congress; 2008

The International Union Against Cancer

Background: In Argentina around 3000 women are diagnosed with cervical cancer annually and around 1600 die due to this disease. The distribution of mortality rates among provinces show a pattern of striking inequality. Whereas Buenos Aires, the national capital city, has a ASR of 3 per 100000, Salta, Jujuy and Misiones, among the poorest provinces in the country, present rates of around 15 per 100000. In addition, cervical cancer mortality has remained mainly unchanged for de last 30 years. These data reflect the fact that in Argentina screening programmes have been introduced piecemeal, lack mechanisms of quality control and information systems to evaluate their effectiveness. In 2007 we carried out the First systematic diagnosis of the National Programme on Cervical Cancer Prevention, funded by the Pan American Health Organization. One key issue of the diagnosis was to evaluate Pap screening coverage at national and regional levels, as well as understanding its socio-demographic determinants. Objectives: To analyse socio-demographic determinants of Pap screening coverage in Argentina. Methods: We analysed data from the first National Survey on Risk Factors carried out by the Ministry of Health (2005). This is a cross-sectional survey, carried out to a probabilistic sample of households selected using a multistage probability sampling design. The sample was representative of the urban population living in cities with 5000 inhabitants or more (96% of urban population). Information on health status, health insurance and socio-demographic characteristics was colleted from one adult per household to obtain representative estimates at national and provincial level. Univariate and multivariate logistic regressions were used to evaluate the effects of the socioeconomic characteristics of women on Pap smear uptake (not having been screened in the last two years and never having been screened).   Results: 23313 women 18 or older were included in the analysis. 48% of women had not been screened in the last two years. Not having been screened in the last two years was associated with older age, lower education, being poor, being the head of the household, having public health insurance, not using contraceptive methods, not being married, and residence in the Northeast, Northwest or Cuyo Region. 25% of women had never been screened. Never having been screened was associated with being less than 35 or over 64, having lower education, being poor, having public health insurance, not using contraceptive methods, not being married, and residence in the Northeast, Northwest or Cuyo Region. Conclusions: The results of this study underscore the need to implement strategies to increase coverage among the most socially vulnerable women. The fact that older women have lower probability of being screened (and contraceptive use is associated to higher probability of Pap screening) suggest that programmes should be re-oriented to focus their efforts in attracting older women that are not in contact with maternal and reproductive health services.