Changes in adherence to cervical cancer screening guidelines before and after the COVID-19 pandemic in the United States.

Abstract

73 Background: The COVID-19 pandemic disrupted several aspects of routine healthcare delivery, many of which have yet to return to pre-pandemic levels of operation. In this study, we compared the adherence rates to cervical cancer screening guidelines in a nationally representative sample of American adults before and following the COVID-19 pandemic. Methods: We included female adults aged 21-65 who participated in the Health Information National Trends Survey (HINTS) 2019 and 2022. Adherence to cervical cancer screening was assessed based on the timing of their last Pap smear test. Participants were classified as non-adherent to cervical cancer guidelines if their last Pap smear test was more than three years ago. Survey-weighted Poisson regression models [adjusted for age, race, and education] were used to explore adherence ratios before and following the COVID-19 pandemic. Results: In 2019, among 1,944 female adults, representing a population of 93,477,003 adults, the mean age (standard deviation [SD]) was 44.5(12.6) years, 61.1% were non-Hispanic White, and 35.2% had a college education or higher. The prevalence of non-adherence to cervical cancer screening was 19.2% [95% CI: 16.3, 22.5]. In adjusted models, being non-Hispanic Black was associated with a lower risk of non-adherence (0.49 [95% CI: 0.30, 0.77] vs. non-Hispanic White), having lower education (less than high school vs. college graduate or higher) was associated with 2.28 [95% CI: 1.21, 4.31] higher likelihood of non-adherence to cervical cancer screening guidelines, while age was not (p>0.05). In 2022, the prevalence of non-adherence to cervical cancer screening was 25.8% [95% CI: 22.9, 29.1]. In adjusted models, having lower education was associated with 1.90 [95% CI: 1.22, 2.97] higher likelihood of non-adherence to cervical cancer screening guidelines, while age and race were not (p>0.05). Compared to 2019, non-adherence rates increased by 6.6% in 2022. When stratified by race, non-Hispanic White adults showed an increase of 5.6% [95% CI: 5.4, 5.6] in non-adherence rates, while non-Hispanic Black adults showed an increase of 13.9% [95% CI: 12.0, 15.2]. Conclusions: There was a decline in adherence to cervical cancer screening guidelines among adult females in the US by about 7% following the COVID-19 pandemic. Additionally, non-Hispanic Black adults and those with lower education showed a disproportionately greater increase in non-adherence rates. These findings are relevant in advancing cervical cancer surveillance in the United States. Further studies are needed to elucidate barriers associated with greater non-adherence rates in minority groups following the pandemic and identify methods to provide more equitable access to healthcare services.