Adherence and Correlates of Cervical Cancer Screening Among East African Immigrant Women in Washington State

Introduction: Cervical cancer screening (CCS) among East African immigrants (EAI) in the USA is under explored. This study aimed to investigate adherence to CCS and its correlates among EAI. Methods: We identified 1664 EAI women (25–65 years) with ≥ 1 primary care clinic visit(s) between 2017 and 2018, using University of Washington (UW) Medicine electronic health record data. CCS adherence was defined as Pap testing within 3 years or human papillomavirus/Pap co-testing within 5 years. We used Poisson regression with robust standard errors to cross-sectionally estimate associations with correlates of adherence. Twelve-month screening uptake was also evaluated among overdue women. Results: CCS adherence was 63%. Factors associated with higher adherence included older age (adjusted prevalence ratios [APRs]:1.47:95%CI:1.14–1.90, 1.38:95%CI:1.05–1.80, respectively, for ages 30–39 and 40–49 vs 25–29 years), longer duration of care at UW Medicine (APR:1.22:95%CI:1.03–1.45, comparing > 10 vs < 5 years), higher visit frequency (APR:1.23:95%CI:1.04–1.44, 1.46:95%CI:1.24–1.72, respectively, for 3–5 and ≥ 6 vs 1–2 visits), index visit in an obstetrics-gynecology clinic (APR:1.26:95%CI:1.03–1.55, vs family practice), having an assigned primary care provider (APR:1.35: 95%CI:1.02–1.79), breast cancer screening adherence (APR:1.66: 95%CI:1.27–2.17), and colorectal cancer screening adherence (APR:1.59:95%CI:1.24–2.03). Low BMI was associated with lower adherence (APR:0.50:95%CI:0.26–0.96, comparing < 18.5 kg/m² vs 18.5–24.9 kg/m²). Among 608 (37%) overdue women, 9% were screened in the subsequent 12 months. Having commercial health insurance vs Medicare/Medicaid was associated with higher uptake (adjusted risk ratio:2.44:95%CI:1.15–5.18). Conclusion: CCS adherence among EAI was lower than the national average of 80%. Interventions focused on increasing healthcare access/utilization or leveraging healthcare encounters to address barriers could increase CCS in EAIs.