Relationship between health care insurance and Papanicolaou exam: a propensity score application using a complex sample inquiry

Revista Brasileira de Epidemiologia

Luiz, Ronir Raggio¹  Moraes, José Rodrigo de²  Paula, Fátima de Lima³  Guimarães, Patrícia Viana¹  Guimarães, Rafael Mendonça¹  Ferreira, Mário Luiz Pinto⁴ 

[1] Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil;Universidade Federal Fluminense, Niterói, Brasil;Fundação Oswaldo Cruz, Rio de Janeiro, Brasil;Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brasil

关键词: National Household Sample Survey (PNAD);    Propensity score;    Health care insurance;    Women's health;    Matched-pair analysis;    Uterine cervical neoplasm;   

DOI  :  10.1590/S1415-790X2011000400006

学科分类：过敏症与临床免疫学

来源: SciELO

【 摘 要 】

Cervical uterinecancer is the second most common malignancy affecting women worldwide. Papanicolaousmear is a simple screening test that can detect the disease at an early andcurable stage. Although indicated to every adult woman, Pap smear screeningcovers less than 70% of Brazilian women. This study aimed to evaluate if privatehealth care insurance coverage was associated with Papanicolaou smear screening.We analyzed data from 6,299 women aged 35 years or older, resident in Rio deJaneiro state, who had been interviewed in the National Household Sample Survey(PNAD) in 2003. In order to minimize the occurrence of biases, we utilized thepropensity score matching method, considering all information from sample designin the scores estimation (sample weights, strata and primary sampling units).A sub-sample of 2,348 women was then obtained, with socioeconomic and biologicalcovariates equally distributed between the groups with and without private healthinsurance coverage (1,174 pairs). Logistic regression model was then used andthe results showed that the chance of Papanicolaou smear screening is 26.1%higher (OR=1.261; p=0,096; CI 95%= [0.96;1.66]) for women with healthinsurance coverage when compared to women without health insurance coverageat 10% of significance. The results indicate the need of extending periodiccervical cancer screening for all women, reducing the inequalities still presentnowadays.

【 授权许可】

CC BY