AI Summary
This article examines factors contributing to differences in cervical cancer screening in rural and urban community health centers (CHCs). The study found that up-to-date cervical cancer screening was lower in rural CHCs compared to urban CHCs, with this difference increasing during the COVID-19 pandemic. Factors such as proportions of patients with limited English proficiency, income below the poverty level, females aged 21 to 64 years, unemployment rates, and primary care physician density were identified as contributors to rural-urban differences in screening rates. The findings suggest the need for tailored interventions to improve screening utilization among marginalized populations in rural CHCs.
Abstract
Introduction
Community health centers (CHCs) provide historically marginalized populations with primary care, including cancer screening. Previous studies have reported that women living in rural areas are less likely to be up to date with cervical cancer screening than women living in urban areas. However, little is known about rural–urban differences in cervical cancer screening in CHCs and the contributing factors, and whether such differences changed during the COVID-19 pandemic.
Methods
Using 8-year pooled Uniform Data System (2014-2021) data and Oaxaca-Blinder decomposition, the extent to which CHC- and catchment area–level characteristics explained rural-urban differences in up-to-date cervical cancer screening was estimated.
Results
Up-to-date cervical cancer screening was lower in rural CHCs than urban CHCs (38.2% vs 43.0% during 2014–2019), and this difference increased during the pandemic (43.5% vs 49.0%). The rural–urban difference in cervical cancer screening in 2014–2019 was mostly explained by differences in CHC-level proportions of patients with limited English proficiency (55.9%) or income below the poverty level (12.3%) and females aged 21 to 64 years (9.8%), and catchment area–level’s unemployment (3.4%) and primary care physician density (3.2%). However, Medicaid (–48.5%) or no insurance (–19.6%) counterbalanced the differences between rural–urban CHCs. The contribution of these factors to rural–urban differences in cervical cancer screening generally increased in 2020–2021.
Conclusions
Rural–urban differences in cervical cancer screening were mostly explained by multiple CHC-level and catchment area–level characteristics. The findings call for tailored interventions, such as providing resources and language services, to improve cancer screening utilization among uninsured, Medicaid, and patients with limited English proficiency in rural CHCs.