Disparities in HPV/PAP Testing Among U.S. Women: A Cross-Sectional Analysis of Healthcare Access, Internet Use, and...

Cervical cancer remain a major public health concern, especially among underserved women. Early detection through Pap or HPV testing reduces incidence and mortality, yet screening disparities persist due to socio-demographic factors, healthcare access, and digital health literacy. Because NHIS does not distinguish between Pap and HPV tests, screening prevalence may be slightly overestimated. This study examines how healthcare access, internet use, and socio-demographic characteristics shape screening behaviors using 2021-2023 NHIS data.

A weighted sample of 106,218,939 U.S. adult women from NHIS was analyzed using logistic regression models. The outcome variable was ever having undergone an HPV or Pap test. Independent variables included healthcare access, internet use, self-reported health status, age, race/ethnicity, education, and marital status. Interaction terms between race/education and race/age were examined to assess subgroup disparities.

Women with a usual place for care (OR = 1.67, p < 0.001) and those who used the internet for health information (OR = 1.54, p < 0.001) had significantly higher odds of undergoing screening. Younger age, higher education, and being single/never married were associated with increased screening participation. Racial/ethnic disparities were evident, with Non-Hispanic Black (OR = 1.41, p < 0.01), Non-Hispanic Asian (OR = 2.96, p < 0.001), and Hispanic women (OR = 1.98, p < 0.001) being more likely to be screened than Non-Hispanic White women. Interaction analyzes revealed that education significantly increased screening rates among Hispanic women, while older Hispanic and NHB women had higher screening odds compared to NHW women in the same age groups.

Healthcare access, digital health literacy, and socio-demographic factors significantly influence cervical cancer screening uptake. Targeted interventions should prioritize early screening adherence, enhance healthcare access, and improve digital health literacy to address disparities in cervical cancer prevention, particularly among younger women and underserved racial/ethnic.