Cervical cancer mortality and socioeconomic determinants of the practice of Pap smear in Argentina

Abstract

Cervical cancer (CC) is the third most incident cancer in women in Argentina, with previous evidence at national level of an inverse association between CC mortality and quality of life. Objectives: a) To identify provincial CC mortality profiles and their preventive practice of PAP in Argentina; b) To analyze the socioeconomic determinants (SED) of PAP practice in women, 2018.

A multigroup ecological study was conducted (n=24 geographic units of Argentina), using secondary data sources (National Survey of Risk Factors -NSRF- 2018; census data; vital statistics from the National Ministry of Health). Age-standardized mortality rates (ASMR) due to CC, weighted prevalence (%) of PAP practice (last 2 years) in women aged 25-65 years, as well as the proportion of women with secondary education incomplete, occupation, health insurance, overcrowding, and access to network gas (as public service) were estimated by geographic unit. A principal components analysis and hierarchical clusters were performed to identify provincial profiles; thematic maps were obtained using QGIS. At the individual level (n=11496 women aged 25-65y; NSRF 2018), a test of difference of proportions (α=0.05) was applied for the prevalence of PAP according to selected SED.

In Argentina, the average ASMR for CC (±SD) was 5.57 (±2.3) deaths per 100,000. Three provincial profiles were identified (explained variance= 78%) called: (1) Higher CC mortality with socioeconomic vulnerability and low preventive practice (NEA and NOA provinces); (2) Lower CC mortality with access to public services (Pampean, Cuyo, and Patagonia regions); (3) Higher prevalence of PAP with favorable socioeconomic conditions (CABA, Tierra del Fuego). The mean percentage of PAP practice was 66%. The prevalence of PAP was significantly higher (p<0.01) in women aged 25-49 years (70.3% vs. 63.8% in 50-65y), married/couple (70.4% vs. 65.3 % without a partner), without overcrowding (68.6% vs. 56.5% with overcrowding), with health insurance (73.8% vs. 56.3% without it), in the highest income quintile (80.9% vs. 55.1% in inferior), and with complete secondary studies (74.5% vs. 56.7% incomplete).

Concluding, there are different profiles and SED related to CC mortality and PAP practice in Argentina, which should be considered in targeted strategies against CC.