Income, Patient Enrolment Model and Cervical Cancer screening uptake within the Central East Local Health Integration Network
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Cervical cancer screening detects cancer at early stages and is available to Ontario women ages 21 to 69 years of age. Notwithstanding cancer screening initiatives, sub-groups of Ontario women are under-screened based on current literature. The most common primary health care delivery system in Ontario are patient enrolment models (PEMs) which allows for physician-incentives when rostering and cancer screening benchmarks are met. Notwithstanding, little is known about the effect of PEM enrolment and other socioeconomic (SES) factors, such as income, on screening uptake. This study considered differences in cervical screening uptake by PEM status and neighbourhood income levels by women residing in the Central East Local Health Integration Network (CELHIN). A descriptive, comparative study using record level, administrative data from Cancer Care Ontario of eligible CELHIN women between January 1, 2012 and June 30, 2015 was conducted (N=490, 574). The variables of interest were cervical screening uptake (dependent variable), PEM status (primary exposure variable), neighbourhood income quintile (independent variable) and controlled for age and rurality. Using logistic regression, it was determined non-enrolled women were more likely not to be screened (OR =6.98, 95% CI, 6.87-7.08) compared to enrolled women, representing the strongest association. Given heterogeneous effects in odds ratios, multivariate stratified logistic regression analyses were undertaken for PEM enrolled and non-enrolled women separately. A significant association was found between older, non-enrolled women (ages 60-69) and not being screened (OR=1.87, 95% CI, 1.78-1.96). Unexpectedly, enrolled women in the lowest neighbourhood income quintile were more likely to not be screened (OR=1.49, 95% CI, 1.46-1.53) compared to their non-enrolled counterparts (OR=1.20, 95% CI, 1.14-1.25). Urban dwellers were slightly less likely to be screened (enrolled women: OR=1.10, 95% CI, 1.07-1.12; non-enrolled women, OR=1.06, 95% CI 1.01-1.11) relative to rural women. As older women have the greatest risk of high-grade invasive cervical cancer and PEM status is not protective for women living in lower SES, the priority for the CELHIN should be addressing barriers to cervical screening uptake, regardless of PEM status, for marginalized at-risk women including older women, and women living in lower SES environments.