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Low Rates of Cervical Cancer Screening Among Urban Immigrants: A Population-Based Study in Ontario, Canada

Lofters, Aisha K. MD*†‡§; Moineddin, Rahim PhD*¶∥; Hwang, Stephen W. MD**‡; Glazier, Richard H. MD*†‡¶∥

doi: 10.1097/MLR.0b013e3181d6886f
Original Article

Objective: Women who are immigrants or socioeconomically disadvantaged have been found to have significantly lower cervical cancer screening rates than their peers in Toronto, Ontario, Canada. The objective of this study was to examine rates of appropriate cervical cancer screening among women living in Ontario, Canada, using recent registration with Ontario's universal health insurance plan as an indicator of immigrant status.

Methods: This retrospective cohort study included 2,273,995 screening-eligible women aged 25 to 69 years, who resided in Ontario's metropolitan areas during the calendar years 2003, 2004, and 2005. A validated algorithm was applied to the Ontario-wide physicians' claims database to determine which women had undergone cervical cancer screening with a Pap test during the 3-year period.

Results: Appropriate cervical cancer screening occurred for 61.1% of women. Despite adjustment for physician contact and pregnancy rates, cervical cancer screening rates were especially low among: women aged 50 to 69 years; women living in low-income areas; and women who had registered with Ontario's universal health insurance plan within the preceding 10 years, a group consisting largely of recent immigrants. Women with all 3 of these characteristics had a screening rate of 31.0% compared with 70.5% among women with none of these characteristics.

Conclusion: Within a system of universal health insurance, appropriate cervical cancer screening is significantly lower among women who are older, living in low-income areas, or recent immigrants. Efforts to reduce disparities in cervical cancer screening should focus on women with these characteristics.


From the *Department of Family & Community Medicine, University of Toronto, Toronto, Canada; †Department of Family & Community Medicine, St. Michael's Hospital, Toronto, Canada; ‡Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada; §Canadian Institutes of Health Research Strategic Training Fellow (Student) in the Transdisciplinary Approach to the Health of Marginalized Populations, Toronto, Canada; ¶Institute for Clinical Evaluative Sciences, Toronto, Canada; ∥Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; and **Department of Medicine, University of Toronto, Toronto, Canada.

Supported by a Canadian Institutes For Health Research (CIHR) Doctoral Award and a CIHR Strategic Training Fellowship in the Transdisciplinary Approach to the Health of Marginalized Populations (to A. L); also supported by the Institute for Clinical Evaluative Sciences (ICES) and the Centre for Research on Inner City Health (CRICH), which are funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC).

The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES, CRICH or the Ontario MOHLTC is intended or should be inferred.

Reprints: Aisha Lofters, MD, St. Michael's Hospital, Department of Family & Community Medicine, 30 Bond St., Toronto, ON, M5B 1W8. E-mail:

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© 2010 Lippincott Williams & Wilkins, Inc.