Inadequate follow-up for abnormal Pap smears in an urban population

• Published in: Journal of the National Medical Association 2003-09, Vol.95 (9), p.825-832
• Main Authors: Peterson, Neeraja B, Han, Jini, Freund, Karen M
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Distribution; Boston - epidemiology; Cervical Intraepithelial Neoplasia - diagnosis; Female; Follow-Up Studies; Health Care Surveys; Health Services Accessibility - statistics & numerical data; Humans; Insurance - statistics & numerical data; Middle Aged; Outcome and Process Assessment (Health Care); Papanicolaou Test; Patient Compliance - statistics & numerical data; Regression Analysis; Urban Population - statistics & numerical data; Vaginal Smears - statistics & numerical data
• ISSN: 0027-9684; 1943-4693

To determine the factors associated with inadequate follow-up for abnormal Pap smears among a cohort of Boston women from urban academic clinics. Subjects were women > 18 years with abnormal cervical cytology between February 1999 and April 2000. Inadequate follow-up was defined as lack of subsequent cervical cytology or pathology specimen within four months of the initial abnormal specimen for high-grade lesions or within 7 months for low-grade lesions. Of the 423 subjects, the mean age was 33 years. Sixty percent were black, 23% Hispanic, 15% white, 2% Asian. The population was largely uninsured or publically insured. The overall inadequate follow-up rate was 38%. In bivariate analysis, age was a significant risk factor; 46% of women ages 18-29 had inadequate follow-up (p < 0.01). In multivariate analysis, women aged 18-29 years were more likely than women 50 years and older to have inadequate follow-up (OR 2.7, 95% CI 1.1-6.4), as were women with Medicaid insurance compared with private insurance (OR 1.9, 95% CI 1.01-3.5). After 12 months, 26% of women with abnormal Pap smears still had not received follow-up. In a predominantly urban minority population, the overall rate of inadequate follow-up for abnormal Pap smears was high at 38%. Programs to address follow-up of abnormal cervical cytology should focus on minority populations, especially younger and all low-income women.