Sociodemographic inequalities in timely PAP test practices among women in Argentina

Abstract

Screening strategies like the Papanicolaou test (PAP) are recognized as effective for secondary cervical cancer prevention, the fourth leading cause of cancer deaths among women in Argentina. Despite geographical disparities in PAP prevalence, more research is needed on its social determinants. This study aimed to identify sociodemographic factors associated with timely PAP practice and analyze provincial-level inequalities in Argentina in 2018. 

A cross-sectional, analytical-observational study included 11,496 women aged 25-65 years (the target group for PAP) from the 2018 National Risk Factor Survey in Argentina (multistage probabilistic sampling). The relationship between timely PAP screening (within the last 2 years) and sociodemographic factors (age, marital status, occupation, health coverage, income, education, and population size) was assessed using the chi-square test (α<0.05). At the ecological level (n=24 jurisdictions), maps were created to calculate the gap (difference between extreme values) in the prevalence of timely PAP screening based on education level (% of women ≥25 years with completed secondary education) and population density (2022 census data, INDEC).

A total of 68.2% of the women reported timely PAP screening. This group was mostly characterized by being 35-49 years old, married/in a union (56.7%), employed (68.1%), with completed secondary education (70%), health insurance (73.2%), and higher income levels (45.5%). Those without timely PAP screening showed higher unemployment/inactivity (42.7%), lower income (53.9% in the 1st-2nd quintile), lower education (48.9% with incomplete secondary education), and residence in areas with 150,000 inhabitants or fewer (61.2%). Significant associations (p<0.01) were found between timely PAP screening and each sociodemographic variable studied. Maps highlighted geographical disparities in PAP prevalence, with a 51-point difference between the jurisdictions with the lowest and highest education levels among women and a 12.9-point difference based on population density. 

In conclusion, timely PAP screening seems influenced by various sociodemographic factors, with education level and population density being key determinants of observed inequalities.