National Healthcare Quality and Disparities Report
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- Access to Care (3)
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- Cancer (14)
- Cancer: Breast Cancer (3)
- (-) Cancer: Cervical Cancer (21)
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- Case Study (1)
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- Racial and Ethnic Minorities (1)
- Risk (1)
- Rural/Inner-City Residents (1)
- Rural Health (2)
- Screening (13)
- Sexual Health (3)
- Shared Decision Making (1)
- Social Media (1)
- Trauma (1)
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- Women (10)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 21 of 21 Research Studies DisplayedDanan ER, Than C, Chawla N
Abnormal cervical cancer screening results among US veteran and non-veteran participants in the National Health Interview Survey (NHIS).
Researchers tested whether Veterans with a recent cervical cancer screening test were more likely than non-Veterans to have received an abnormal result. Data was taken from the National Health Interview Survey (NHIS). An adjusted regression model of the date indicated that a previously observed association between Veteran status and abnormal screening result was explained by differences in sociodemographic and health factors between Veterans and non-Veterans. The researchers concluded that clinicians should address modifiable risk factors and provide evidence-based follow-up for abnormal results.
AHRQ-funded; HS026379.
Citation: Danan ER, Than C, Chawla N .
Abnormal cervical cancer screening results among US veteran and non-veteran participants in the National Health Interview Survey (NHIS).
Prev Med Rep 2023 Dec; 36:102472. doi: 10.1016/j.pmedr.2023.102472..
Keywords: Cancer: Cervical Cancer, Cancer, Screening, Women, Prevention
McGee-Avila JK, Richmond J, Henry KA
Disparities in geospatial patterns of cancer care within urban counties and structural inequities in access to oncology care.
This study examined geospatial patterns of cancer care utilization across diverse populations in New Jersey-a state where most residents live in urban areas. The authors used data from the New Jersey State Cancer Registry. They examined the location of cancer treatment among patients 20-65 years of age diagnosed with breast, colorectal, or invasive cervical cancer and investigated differences in geospatial patterns of care by individual and area-level (e.g., census tract-level) characteristics. They observed significant differences in geospatial patterns of cancer treatment by race/ethnicity, insurance type, and area-level factors. They found that Black patients had a 5.6% higher likelihood of receiving care within their own residential county compared to non-Hispanic White patients. Patients living in census tracts with the highest quintile of social vulnerability were 4.6% more likely to receive treatment within their residential county and were 2.7% less likely to seek out-of-state care.
AHRQ-funded; HS026122.
Citation: McGee-Avila JK, Richmond J, Henry KA .
Disparities in geospatial patterns of cancer care within urban counties and structural inequities in access to oncology care.
Health Serv Res 2023 Aug; 58(Suppl 2):152-64. doi: 10.1111/1475-6773.14182..
Keywords: Disparities, Urban Health, Rural/Inner-City Residents, Cancer, Cancer: Breast Cancer, Cancer: Colorectal Cancer, Cancer: Cervical Cancer
Estenson L, Kim N, Jacobson M
Do age-based discontinuation recommendations influence cervical cancer screening rates? Evidence from the United States' Behavioral Risk Factor Surveillance System, 2016 and 2018.
The purpose of this study was to determine how the United States Preventive Services Task Force (USPSTF) recommendation of discontinuing routine cervical cancer screening for certain women after age 65 affects Papanicolaou (Pap) test rates among women at age 66 in the United States. The researchers utilized nationally representative 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) data for 226,031 women ages 56-76 to calculate changes in annual Pap test rates at age 66. Among women 66-76, 22.5% indicated they had received a Pap test within the past year. At age 66, annual Pap rates decreased by 5.9 percentage points (p.p.) off a pre-66 rate of 39 percent. The change differed by race/ethnicity, education, and marital status. Pap rates did not change discretely for non-Hispanic Black women but did change for women from other racial/ethnic groups. The decrease was larger for women who graduated college than for women without a college degree and for women who were never married than for women who were married/partnered or divorced/separated. The USPSTF recommendation to stop cervical cancer screening after the age of 65 resulted in a substantial decrease in the rate of Pap tests at age 66 but disparately affects women based on marital status, education and race.
AHRQ-funded; HS026488.
Citation: Estenson L, Kim N, Jacobson M .
Do age-based discontinuation recommendations influence cervical cancer screening rates? Evidence from the United States' Behavioral Risk Factor Surveillance System, 2016 and 2018.
Prev Med 2023 Jul; 172:107543. doi: 10.1016/j.ypmed.2023.107543..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Cervical Cancer, Cancer, Screening, Prevention, Evidence-Based Practice, Women, Sexual Health
Danan ER, Brunner J, Bergman A
The relationship between sexual assault history and cervical cancer screening completion among women veterans in the Veterans Health Administration.
The purpose of this study was to determine whether a history of sexual assault in women Veterans is associated with decreased cervical cancer screening completion. The researchers analyzed data from a 2015 survey of 1049 women Veterans who accessed primary care services at 12 Veterans health administration facilities (VA’s) in nine states, and linked responses with electronic health data from the VA system. Fifty-seven percent (616) of women Veterans reported lifetime sexual assault, and those who did so had a greater likelihood of reporting a high level of distress associated with pelvic examinations and delaying a gynecologic exam due to distress. However, in the final adjusted model, there was not a significant association between lifetime sexual assault and reduced odds of cervical cancer screening completion. The study concluded that there was no significant association between sexual assault and gaps in cervical cancer screening completion.
AHRQ-funded; HS026379.
Citation: Danan ER, Brunner J, Bergman A .
The relationship between sexual assault history and cervical cancer screening completion among women veterans in the Veterans Health Administration.
J Womens Health 2022 Jul;31(7):1040-47. doi: 10.1089/jwh.2021.0237.AHRQ-funded; HS026379..
Keywords: Women, Cancer: Cervical Cancer, Cancer, Screening, Trauma
Fendrick AM, Dalton VK, Tilea A
Out-of-pocket costs for colposcopy among commercially insured women from 2006 to 2019.
The objective of this study was to describe out-of-pocket costs for colposcopy and related services among age-appropriate, commercially insured women from 2006 to 2019. Findings suggested that out-of-pocket costs for colposcopy were very common and significant and have increased over time. Reported out-of-pocket costs for cervical cancer screening-related care, such as office visits, were not included, thus the findings may underestimate patients’ total financial burden.
AHRQ-funded; HS025465.
Citation: Fendrick AM, Dalton VK, Tilea A .
Out-of-pocket costs for colposcopy among commercially insured women from 2006 to 2019.
Obstet Gynecol 2022 Jan;139(1):113-15. doi: 10.1097/aog.0000000000004582..
Keywords: Healthcare Costs, Colonoscopy, Screening, Cancer: Cervical Cancer, Cancer, Prevention, Women
Glenn BA, Nonzee NJ, Tieu L
Human papillomavirus (HPV) vaccination in the transition between adolescence and adulthood.
This study looked at the barriers to human papillomavirus (HPV) vaccination among young adults receiving care at the student health center of a large public university. The authors conducted semi-structured interviews (n=27) and four focus groups with undergraduate and graduate students (n=18) and semi-structured interviews with 6 health care providers. The interviews and focus groups explored perceived risk of HPV infection, benefits of the HPV vaccine, and motivations for and barriers to HPV vaccination. Many students cited their parents’ views and recommendations from their medical providers as influential on their decision-making process. Cervical cancer prevention was considered the main benefit of the HPV vaccine and sexual activity was a risk factor for HPV infection. Students often lacked knowledge about the vaccine’s benefit for males. Safety and side effects of the vaccine perceived as new were also cited. Providers’ vaccine recommendations were impacted by health system factors including clinical infrastructure, office visit priorities, and processes for recommending and documentation vaccination. Providers suggested various promotion strategies including improving the timing and messaging of outreach efforts on campus and bolstering clinical infrastructure.
AHRQ-funded; HS000046.
Citation: Glenn BA, Nonzee NJ, Tieu L .
Human papillomavirus (HPV) vaccination in the transition between adolescence and adulthood.
Vaccine 2021 Jun 8;39(25):3435-44. doi: 10.1016/j.vaccine.2021.04.019..
Keywords: Young Adults, Sexual Health, Infectious Diseases, Vaccination, Prevention, Cancer: Cervical Cancer, Cancer, Women
Asti L, Hopley C, Avelis C
The potential clinical and economic value of a human papillomavirus primary screening test that additionally identifies genotypes 31, 45, 51, and 52 individually.
This study looked at the potential clinical and economic value of a human papillomavirus (HPV) primary screening test that additionally identified genotypes 31,45,51, and 52 along with genotypes 16 and 18. The authors developed a Markov model of the HPV disease course and evaluated the clinical and economic value of HPV primary screening with Onclarity. Currently HPV primary screening results in 25,194 invasive procedures and 48 invasive cervical cancer (ICC) cases per 100,000 women. Screening with extended genotyping and later screening women with certain genotypes averted 903 to 3163 invasive procedures and results in 0 to 3 more ICC cases compared with current primary screening tests. Extended genotyping was cost effective when costing $75 and cost saving when costing $43. When the probabilities of disease progression increased 2-4 times, it was not cost-effective because it resulted in more ICC cases and accrued fewer quality-adjusted life-years.
AHRQ-funded; HS023317.
Citation: Asti L, Hopley C, Avelis C .
The potential clinical and economic value of a human papillomavirus primary screening test that additionally identifies genotypes 31, 45, 51, and 52 individually.
Sex Transm Dis 2021 May;48(5):370-80. doi: 10.1097/olq.0000000000001327.
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Keywords: Sexual Health, Infectious Diseases, Screening, Diagnostic Safety and Quality, Genetics, Cancer: Cervical Cancer, Cancer, Women
Hatch B, Hoopes M, Darney BG
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Researchers assessed whether ACA implementation and Medicaid expansion were followed by greater receipt of recommended preventive services among women and girls in a large network of community health centers. Data was collected from electronic health records in 14 states. The researchers found that among female patients at community health centers, receipt of recommended preventive care improved after ACA implementation in both Medicaid expansion and non-expansion states, although the overall rates remained low. They recommended continued support to overcome barriers to preventive care in this population.
AHRQ-funded; HS025155.
Citation: Hatch B, Hoopes M, Darney BG .
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Womens Health Issues 2021 Jan-Feb;31(1):9-16. doi: 10.1016/j.whi.2020.08.011..
Keywords: Cancer, Medicaid, Health Insurance, Uninsured, Access to Care, Policy, Cancer: Cervical Cancer, Prevention, Women, Healthcare Utilization
Pollack LM, Ekwueme DU, Hung MC Pollack LM, Ekwueme DU, Hung MC, Pollack LM, Ekwueme DU, Hung MC Pollack LM, Ekwueme DU, Hung MC, Hung MC
Estimating the impact of increasing cervical cancer screening in the National Breast and Cervical Cancer Early Detection Program among low-income women in the USA.
The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides free cervical cancer screening to low-income women. This study estimated the health benefits gained in terms of life years (LYs) saved and quality-adjusted life years (QALYs) gained if cervical cancer screening by the NBCCEDP increased to reach more eligible women. The investigators found that the reported estimates emphasized the value of cervical cancer screening program by extending LE in low-income women.
Citation: Pollack LM, Ekwueme DU, Hung MC Pollack LM, Ekwueme DU, Hung MC, Pollack LM, Ekwueme DU, Hung MC Pollack LM, Ekwueme DU, Hung MC, Hung MC .
Estimating the impact of increasing cervical cancer screening in the National Breast and Cervical Cancer Early Detection Program among low-income women in the USA.
Cancer Causes Control 2020 Jul;31(7):691-702. doi: 10.1007/s10552-020-01314-z..
Keywords: Medical Expenditure Panel Survey (MEPS), Cancer: Cervical Cancer, Cancer: Breast Cancer, Cancer, Screening, Women, Diagnostic Safety and Quality, Low-Income
Rohner E, Butikofer L, Schmidlin K
Cervical cancer risk in women living with HIV across four continents: a multicohort study.
In this study, the investigators compared invasive cervical cancer (ICC) incidence rates in Europe, South Africa, Latin and North America among women living with HIV who initiated antiretroviral therapy (ART) between 1996 and 2014. The investigators concluded that improving access to early ART initiation and effective cervical cancer screening in women living with HIV should be key parts of global efforts to reduce cancer-related health inequities.
AHRQ-funded; 90047713.
Citation: Rohner E, Butikofer L, Schmidlin K .
Cervical cancer risk in women living with HIV across four continents: a multicohort study.
Int J Cancer 2020 Feb;146(3):601-09. doi: 10.1002/ijc.32260..
Keywords: Cancer: Cervical Cancer, Cancer, Human Immunodeficiency Virus (HIV), Women, Medication, Chronic Conditions
Lyson HC, Le GM, Zhang J
Social media as a tool to promote health awareness: results from an online cervical cancer prevention study.
In this study, the authors investigated whether participation in an online social media platform and receipt of brief, tailored messages was effective at increasing knowledge, awareness, and prevention behaviors related to human papillomavirus (HPV) and cervical cancer. The investigators found that although most study participants had substantial knowledge, awareness, and engagement in positive behaviors related to cervical cancer prevention at the start of the study, HPV awareness could be increased through brief participation in an online social media platform and receipt of tailored health messages.
AHRQ-funded; HS022241.
Citation: Lyson HC, Le GM, Zhang J .
Social media as a tool to promote health awareness: results from an online cervical cancer prevention study.
J Cancer Educ 2019 Aug;34(4):819-22. doi: 10.1007/s13187-018-1379-8..
Keywords: Social Media, Cancer: Cervical Cancer, Cancer, Health Promotion, Prevention
Huguet N, Angier H, Rdesinski R
Cervical and colorectal cancer screening prevalence before and after Affordable Care Act Medicaid expansion.
This study assessed changes in the prevalence of cervical and colorectal cancer screening from before and after the Affordable Care Act in Medicaid expansion and non-expansion states among patients seen in community health centers. Results showed that, despite increased prevalences of cervical and colorectal cancer screening in both expansion and non-expansion states across all race/ethnicity groups, rates remained suboptimal for this population of socioeconomically disadvantaged patients.
AHRQ-funded; HS024270.
Citation: Huguet N, Angier H, Rdesinski R .
Cervical and colorectal cancer screening prevalence before and after Affordable Care Act Medicaid expansion.
Prev Med 2019 Jul;124:91-97. doi: 10.1016/j.ypmed.2019.05.003..
Keywords: Cancer, Cancer: Cervical Cancer, Cancer: Colorectal Cancer, Healthcare Delivery, Healthcare Utilization, Medicaid, Policy, Prevention, Screening
Spees LP, Brewster WR, Varia MA
Examining urban and rural differences in how distance to care influences the initiation and completion of treatment among insured cervical cancer patients.
Although rural cancer patients encounter substantial barriers to care, they more often report receiving timely care than urban patients. In this study, the investigators examined whether geographic distance, a contributor to urban-rural health disparities, differentially influenced treatment initiation and completion among insured urban and rural cervical cancer patients. The investigators found that geographic distance differentially influenced the initiation and completion of treatment among urban and rural cervical cancer patients.
AHRQ-funded; HS000032.
Citation: Spees LP, Brewster WR, Varia MA .
Examining urban and rural differences in how distance to care influences the initiation and completion of treatment among insured cervical cancer patients.
Cancer Epidemiol Biomarkers Prev 2019 May;28(5):882-89. doi: 10.1158/1055-9965.Epi-18-0945..
Keywords: Rural Health, Urban Health, Disparities, Access to Care, Cancer: Cervical Cancer, Cancer
Ngo-Metzger Q, Adsul P
AHRQ Author: Ngo-Metzger Q
Screening for cervical cancer.
This case study describes a 48-year-old woman, non-smoker, who has no history of sexually transmitted diseases or other remarkable conditions in her medical history. She had a human papillomavirus (HPV) test and a Pap smear three years ago, the results of both negative. The woman’s 19-year-old daughter has recently become sexually active and the woman wonders if she should schedule a Pap smear for her daughter. The case study questions are based on USPSTF recommendations for cervical cancer screening and the updated evidence report and systematic review on screening for cervical cancer with high-risk human papillomavirus testing.
AHRQ-authored.
Citation: Ngo-Metzger Q, Adsul P .
Screening for cervical cancer.
Am Fam Physician 2019 Feb 15;99(4):253-54.
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Keywords: Cancer: Cervical Cancer, Case Study, Prevention, Screening, U.S. Preventive Services Task Force (USPSTF)
Spees LP, Wheeler SB, Varia M
Evaluating the urban-rural paradox: the complicated relationship between distance and the receipt of guideline-concordant care among cervical cancer patients.
A recent study suggests that the distance to reach care may affect urban and rural cancer patients differentially; the authors of this article examined whether or not this urban-rural paradox exists among cervical cancer patients. Patients diagnosed with cervical cancer from 2004 to 2013 were identified via a statewide cancer registry linked to multi-payer insurance claims. 62% of the cervical cancer patients received guideline-concordant care. The association between distance and receipt of care differed by type of treatment. The authors conclude that there is evidence supporting the urban-rural paradox.
AHRQ-funded; HS000032.
Citation: Spees LP, Wheeler SB, Varia M .
Evaluating the urban-rural paradox: the complicated relationship between distance and the receipt of guideline-concordant care among cervical cancer patients.
Gynecol Oncol 2019 Jan;152(1):112-18. doi: 10.1016/j.ygyno.2018.11.010.
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Keywords: Access to Care, Cancer: Cervical Cancer, Disparities, Evidence-Based Practice, Rural Health, Urban Health
Kim JJ, Burger EA, Regan C
Screening for cervical cancer in primary care: a decision analysis for the US Preventive Services Task Force.
The purpose of this study was to inform the US Preventive Services Task Force by modeling the benefits and harms of various cervical cancer screening strategies. In this microsimulation modeling study, it was estimated that primary hrHPV screening may represent a reasonable balance of harms and benefits when performed every 5 years. Switching from cytology to hrHPV testing at age 30 years yielded the most efficient harm to benefit ratio when using colposcopy as a proxy for harms.
AHRQ-funded; 290-2012-00015-I.
Citation: Kim JJ, Burger EA, Regan C .
Screening for cervical cancer in primary care: a decision analysis for the US Preventive Services Task Force.
JAMA 2018 Aug 21;320(7):706-14. doi: 10.1001/jama.2017.19872..
Keywords: Cancer: Cervical Cancer, Shared Decision Making, Primary Care, Screening, U.S. Preventive Services Task Force (USPSTF)
Melnikow J, Henderson JT, Burda BU J, Henderson JT, Burda BU
Screening for cervical cancer with high-risk human papillomavirus testing: updated evidence report and systematic review for the US Preventive Services Task Force.
Cervical cancer can be prevented with detection and treatment of precancerous cell changes caused primarily by high-risk types of human papillomavirus (hrHPV), the causative agents in more than 90% of cervical cancers. The objective of this study was to systematically review benefits and harms of cervical cancer screening for hrHPV to inform the US Preventive Services Task Force.
AHRQ-funded; 290201200015I.
Citation: Melnikow J, Henderson JT, Burda BU J, Henderson JT, Burda BU .
Screening for cervical cancer with high-risk human papillomavirus testing: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2018 Aug 21;320(7):687-705. doi: 10.1001/jama.2018.10400..
Keywords: Cancer: Cervical Cancer, Evidence-Based Practice, Infectious Diseases, Screening, U.S. Preventive Services Task Force (USPSTF)
Ravikumar KE, MacLaughlin KL, Scheitel MR
Improving the accuracy of a clinical decision support system for cervical cancer screening and surveillance.
Researchers sought to enhance a clinical decision support system (CDSS) by improving its accuracy and incorporating changes to reflect the latest revision of the guidelines. The recommendation accuracy of the enhanced CDSS improved to 93 percent, which is a substantial improvement over the 84 percent reported previously. A detailed analysis of errors is presented in this article.
AHRQ-funded; HS022911.
Citation: Ravikumar KE, MacLaughlin KL, Scheitel MR .
Improving the accuracy of a clinical decision support system for cervical cancer screening and surveillance.
Appl Clin Inform 2018 Jan;9(1):62-71. doi: 10.1055/s-0037-1617451.
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Keywords: Cancer: Cervical Cancer, Clinical Decision Support (CDS), Prevention, Screening
Kim SC, Glynn RJ, Giovannucci E
Risk of high-grade cervical dysplasia and cervical cancer in women with systemic inflammatory diseases: a population-based cohort study.
This study assessed the risk of high-grade cervical dysplasia, a surrogate endpoint for cervical cancer and cervical cancer, in women with systemic inflammatory diseases (SID), including IBD, psoriasis, rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE), compared with the risk in women without SID. It found that the risk of high-grade cervical dysplasia and cervical cancer was 1.5 times higher in women with RA and SLE than in those without SID.
AHRQ-funded; HS018533.
Citation: Kim SC, Glynn RJ, Giovannucci E .
Risk of high-grade cervical dysplasia and cervical cancer in women with systemic inflammatory diseases: a population-based cohort study.
Ann Rheum Dis 2015 Jul;74(7):1360-7. doi: 10.1136/annrheumdis-2013-204993..
Keywords: Arthritis, Risk, Women, Cancer: Cervical Cancer, Cancer
Thompson CA, Gomez SL, Chan A
Patient and provider characteristics associated with colorectal, breast, and cervical cancer screening among Asian Americans.
The researchers performed multivariable modeling to evaluate potential predictors (at the provider- and patient-level) of screening completion among Asian patients. They concluded that language- and gender-concordant primary care providers and culturally tailored online health resources may help improve preventive cancer screening in Asian patient populations.
AHRQ-funded; HS019815.
Citation: Thompson CA, Gomez SL, Chan A .
Patient and provider characteristics associated with colorectal, breast, and cervical cancer screening among Asian Americans.
Cancer Epidemiol Biomarkers Prev 2014 Nov;23(11):2208-17. doi: 10.1158/1055-9965.epi-14-0487..
Keywords: Cancer: Breast Cancer, Cancer: Cervical Cancer, Cancer: Colorectal Cancer, Healthcare Utilization, Screening
Percac-Lima S, Benner CS, Lui R
The impact of a culturally tailored patient navigator program on cervical cancer prevention in Latina women.
The authors evaluated the impact of patient navigation on cervical cancer prevention in Latinas. They found that patient navigation can prevent cervical cancer in Latina women by increasing colposcopy clinic attendance, shortening time to colposcopy, and decreasing severity of cervical abnormalities over time.
AHRQ-funded; HS019161.
Citation: Percac-Lima S, Benner CS, Lui R .
The impact of a culturally tailored patient navigator program on cervical cancer prevention in Latina women.
J Womens Health 2013 May;22(5):426-31. doi: 10.1089/jwh.2012.3900.
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Keywords: Cancer: Cervical Cancer, Cultural Competence, Prevention, Racial and Ethnic Minorities, Screening