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

Peterson NB, Han J, Freund KM
J Natl Med Assoc. 2003 95 (9): 825-32

PMID: 14527050 · PMCID: PMC2594474

PURPOSE - To determine the factors associated with inadequate follow-up for abnormal Pap smears among a cohort of Boston women from urban academic clinics.

METHODS - 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.

RESULTS - 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.

CONCLUSIONS - 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.

MeSH Terms (18)

Adolescent Adult Age Distribution Boston Cervical Intraepithelial Neoplasia Female Follow-Up Studies Health Care Surveys Health Services Accessibility Humans Insurance Middle Aged Outcome and Process Assessment, Health Care Papanicolaou Test Patient Compliance Regression Analysis Urban Population Vaginal Smears

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