[Relationship between health care insurance and Papanicolaou exam: a propensity score application using a complex...

Cervical uterine cancer is the second most common malignancy affecting women worldwide. Papanicolaou smear is a simple screening test that can detect the disease at an early and curable stage. Although indicated to every adult woman, Pap smear screening covers less than 70% of Brazilian women. This study aimed to evaluate if private health care insurance coverage was associated with Papanicolaou smear screening. We analyzed data from 6,299 women aged 35 years or older, resident in Rio de Janeiro state, who had been interviewed in the National Household Sample Survey (PNAD) in 2003. In order to minimize the occurrence of biases, we utilized the propensity score matching method, considering all information from sample design in the scores estimation (sample weights, strata and primary sampling units). A sub-sample of 2,348 women was then obtained, with socioeconomic and biological covariates equally distributed between the groups with and without private health insurance coverage (1,174 pairs). Logistic regression model was then used and the results showed that the chance of Papanicolaou smear screening is 26.1% higher (OR=1.261; p=0,096; CI 95%= [0.96;1.66]) for women with health insurance coverage when compared to women without health insurance coverage at 10% of significance. The results indicate the need of extending periodic cervical cancer screening for all women, reducing the inequalities still present nowadays.