ASSOCIATION OF SOCIAL DETERMINANTS OF HEALTH AND COVID-19-RELATED BEHAVIORS WITH CERVICAL CANCER SCREENING IN HISPANIC WOMEN

ABSTRACT

While cervical cancer is highly preventable through early detection, Hispanic women are 40% more likely to develop cervical cancer and 20% more likely to die from the disease compared to non-Hispanic Whites (NHWs) in the U.S. Specifically, the COVID-19 pandemic resulted in decreased screenings due to safety concerns;however, very limited information is available to evaluate the COVID-19 disruptions on cervical cancer screenings among Hispanics. This study investigated the association of social determinants of health (SDOH) and COVID-19-related behaviors with cervical cancer screening among Hispanic women. The National Institutes of Health (NIH) All of Us data was utilized, in which Hispanic (N = 37,253), NHW (N = 75,756), and non-Hispanic Black (NHB;N = 32,325) women aged 21 to 65 years were included. Within- and between-group characteristics were analyzed using descriptive statistics. Differences in measured variables between Hispanic and NHW women were investigated by performing Wilcoxon test/Student's t-test for continuous variables and Pearson chi-square/Fisher's exact test for categorical variables. Logistic regression models were used to estimate nonadherence to cervical cancer screening. Data analysis was performed in R using Jupyter Notebook in the All of Us research workbench. The rate of cervical cancer screening averaged 2-3% for all ethnic groups, with Hispanic women consistently averaging lower than NHB and NHW women in 20172020 (p<.05). There was a noticeable drop in cervical cancer screening rates (0.92-1.03%) in 2021. Among the women adherent to cervical cancer screening, Hispanics demonstrated non-optimal SDOH and poorer general health status and lifestyle habits, as well as tended to be obese compared to NHWs. In Hispanics, social distance-related stress was significantly associated with adherence to cervical cancer screening during COVID-19 (p=.034). In the adjusted regression model with demographics, health status, and COVID-19 factors, the age group of 41-50, higher income, human papillomavirus (HPV) vaccination, and more social distance-related stress were associated with lower odds of nonadherence. Better general health status and 2nd COVID-19 vaccination were associated with higher odds of nonadherence. Our results suggest that SDOH and COVID-19-related behaviors are associated with cervical cancer screening in Hispanics. The knowledge gained could provide new insights into outreach efforts to prevent Hispanic individuals at risk from suffering the consequences of delayed screening and diagnosis and later-stage presentation of cervical cancer. The findings will inform future public health guidelines for planning Pap and HPV screening.