Individual and Geographical Factors Associated With Follow-Up Care After an Abnormal Cervical Cancer Screening Result

Guideline-concordant screening and timely follow-up of abnormal results aid in the prevention and early diagnosis of cervical cancer. From a cohort of Mississippi patients screened for cervical cancer in 2018-2021, we identified those with abnormal screening results and examined variables associated with follow-up care.

We performed a retrospective analysis of electronic health record data to identify individuals with an abnormal screening result in the STRIDES (STudying Risk to Improve DisparitiES) cohort between February 2018 and August 2021 to identify documented follow-up with clinically indicated colposcopy. We evaluated associations of individual-level (i.e., age, race, cytology, residential region, driving distance) and neighborhood-level socioeconomic factors (i.e., residential rurality, social vulnerability) with documentation of follow-up colposcopy using multilevel logistic regression models.

The strongest predictors of lacking documented follow-up included age <30 (adjusted odds ratio [aOR] = 1.86; 95% confidence interval [CI]: 1.41-2.43), residence in the Northern (aOR = 2.26, 95% CI [1.59, 3.23]) or Central region (aOR = 1.43, 95% CI [1.00, 2.04]), non-Hispanic Asian race (aOR = 1.54, 95% CI [1.02, 2.33]), and greater driving distance to care (aOR = 1.01 per mile, 95% CI [1.00, 1.02]). Individuals whose cervical screening results showed any abnormal cytology cells were more likely to have documented follow-up care than those whose results appeared normal but tested positive for high-risk human papillomavirus. The likelihood of documented follow-up increased with severity of abnormality of the cytology result.

Our findings suggest that individual and neighborhood geographical factors, such as age, location, distance to care, and severity of cytology result, are associated with documented follow-up cervical cancer care. These findings will inform future efforts to identify and address barriers and facilitators to accessing and completing cervical cancer care, with the goal of reducing health disparities in cervical cancer prevention statewide.