Cervical cancer screening among women in metropolitan areas of the United States by individual-level and area-based measures of socioeconomic status, 2000 to 2002

Background: Few studies have examined cancer screening among women residing in metropolitan areas in relation to both individual-level and area-based measures of socioeconomic status (SES). To learn more, we examined self-reported rates of Papanicolaou (Pap) testing among women living in metropolitan areas in relation to individual-level measures of SES (household income and education), and area-based measures of SES (percentage of residents living in poverty, percentage with low education, and percentage working class). Methods: Data were obtained from women who were interviewed by telephone during 2000 and 2002 as part of the Behavioral Risk Factor Surveillance System (BRFSS). Self-reported county of residence was used to classify respondents as residents of metropolitan statistical areas. Only BRFSS respondents who resided in 35 metropolitan statistical areas with a population of >= 1.5 million in 2000 were included in this analysis. Analyses were limited to women ages >= 18 years with no history of hysterectomy (n = 49,231). Area-based measures of SES were obtained by using county-level information from the 2000 U.S. Census. Results: Only 75.4% [95% confidence interval (95% CI), 73.8-77.1%] of 3,947 women ages >= 18 years who had a reported household income of <$15,000 per year had received a Pap test in the previous 3 years, compared with 92.2% (95% CI, 91.2-93.1%) of 18,698 women with a household income of >=$50,000. Overall, 77.5% (95% CI, 75.7-79.3%) of women without a high school education had received a Pap test compared with 91.7% (91.0-92.3%) of college graduates. In multivariate analysis, we also found education level to be positively associated with Pap testing rates, especially among women residing in areas where a relatively low percentage of residents had a low education level (P < 0.0001). Conclusions: Individual-level measures of SES may be modified by county-level measures of SES. Analyses of cancer screening rates by measures of income, educational attainment, and other factors may help health officials to better direct their finite resources to areas of greatest need.