Adherence to cervical cancer screening among sexual and racial/ethnic minorities during the COVID-19 pandemic in the United States.

Abstract

e22530 Background: Sexual and racial minorities face barriers to accessing health care. While the association of sexual orientation and racial identity with cervical cancer screening adherence have been previously reported, no study was conducted during the COVID-19 pandemic. Methods: Using the 2021 NHIS data, we conducted a cross-sectional study that included female respondents aged 21 to 65 years with no history of hysterectomy. The primary outcome was the USPSTF guideline–concordant cervical cancer screening adherence. The main predictors were sexual orientation, racial/ethnic identity and covid-19 vaccination. Weighted logistic regression analyzes were performed to examine factors associated with cervical cancer screening adherence. Results: Among 7,746 women included in this study, most were non-Hispanic Whites (63.4%), straight (92.2%), and vaccinated against covid-19 (69.3%). Overall, 5,793 women (74.8%) were classified as cervical cancer screening adherents. Non-straight women had 28% lower odds of adhering to cervical cancer screening guidelines (aOR: 0.72 [95%CI: 0.52–0.99]) compared their straight counterpart, and Asians had 46% lower had lower odds of adhering to cervical cancer screening guidelines (aOR: 0.54 [95%CI: 0.40–0.73]) compared to non-Hispanic Whites. Individuals who reported being vaccinated against COVID-19 had significantly higher odds of adhering to cervical cancer screening guidelines compared to COVID-19 unvaccinated ones (aOR: 1.35, [1.12 – 1.63]). Conclusions: Our study found lower odds of cervical cancer screening adherence among sexual and racial/ethnic minorities in the US. Cultural adaptation of interventions aimed at removing cervical cancer screening barriers in these minority groups is needed to reduce existing disparities. The lower odds of cervical cancer screening adherence among COVID-19 unvaccinated individuals stresses the need to develop tailored strategies targeting these individuals to further boost cervical cancer screening in the US. Factors associated with cervical cancer screening adherence among eligible women in the US during the COVID-19 pandemic. Characteristics Adjusted odd ratios 95% CL P-value Age 45-65 Ref. 21-45 1.26 1.06 – 1.49 0.0073 Sexual orientation Straight Ref. Non-straight* 0.72 0.52 – 0.99 0.048 Race/Ethnicity Non-Hispanic White Ref. Non-Hispanic Black 1.04 0.80 – 1.35 0.7888 Hispanic 0.89 0.67 – 1.18 0.4116 Asian 0.54 0.40 – 0.73 0.0001 Marital Status Not Married/Other Ref. Married/living with a partner 2.15 1.80 – 2.56 <0.0001 Birthplace US Ref. Abroad 0.60 0.47 – 0.77 0.0001 Not Available 1.64 0.48 – 5.66 0.4299 Poverty-to-income ratio ≥ 2 Ref. < 2 0.81 0.66 – 1.00 0.0543 Health insurance Yes Ref. No 0.42 0.32 – 0.55 <0.0001 Receipt of COVID-19 vaccination No Ref. Yes 1.35 1.12 – 1.63 0.0018 *Non-straight include gay/lesbian; bisexual; something else; don’t know.