Racial/Ethnic Disparities in the Burden of HIV/Cervical Cancer Comorbidity and Related In-hospital Mortality in the USA

Time Differences From Abnormal Cervical Cancer Screening to Colposcopy Between Insurance Statuses

OBJECTIVE

Screening and diagnostic follow-up to prevent cervical cancer are influenced by socioeconomic and systemic factors. This study sought to characterize intervals from abnormal cervical cancer screening to colposcopy between practices differing by insurance status at a large, urban academic center.

MATERIALS AND METHODS

This retrospective cohort study included patients aged 21-65 who presented for colposcopy between January 1, 2021, and January 1, 2022, at the resident and faculty gynecology practices of a single large urban academic medical center. Patient characteristics were compared using t tests or Wilcoxon rank sum tests for continuous measures and χ 2 or Fisher exact tests for categorical measures. Intervals from abnormal cervical cancer screening to colposcopy were compared using the Wilcoxon rank sum test and linear regression analysis with multivariable models adjusted for age, cervical cytology result, human papillomavirus result, and HIV status.

RESULTS

Resident practice patients were publicly insured and more likely to be Black or Hispanic ( p < .0001); rates of high-risk human papillomavirus and smoking were similar. Resident practice patients had longer intervals from abnormal cervical cancer screening to colposcopy compared with faculty practice patients (median 79.5 vs 34 d, p < .0001). On adjusted analysis, resident practice patients faced a 95% longer interval ( p < .0001).

CONCLUSIONS

Publicly insured patients of a resident-based practice faced significantly longer intervals from abnormal cervical cancer screening to colposcopy than faculty practice patients at a single urban academic center. Effort to address these differences may be an area of focus in improving health disparities.

Cervical Cancer Screening Among Older Garifuna Women Residing in New York City

This study examined the level of adherence to the recommended cervical cancer screening guidelines among Garifuna women residing in New York City, and screening practice association with demographic factors, access to healthcare services, perceptions/barriers to cervical cancer screening, acculturation, identity, and level of screening guideline knowledge. Four hundred Garifuna women were surveyed. The study results reveal low self-reported cervical cancer screening rates (60%), increased age, visiting a Garifuna healer in the past year, perceived benefits of receiving the screening test, and knowledge of the Pap test as having the highest predictive variability for receiving cervical cancer screening. The odds of having a Pap test were significantly lower in older women (age 65 years and above) and those visiting a traditional healer within the past year. The study findings provide several implications for developing culturally appropriate interventions aimed to increase the level of cervical cancer screening in this unique immigrant group.

Racial and neighborhood disparities in mortality among hospitalized COVID-19 patients in the United States: An analysis of the CDC case surveillance database

BACKGROUND

Black and Hispanic populations have higher overall COVID-19 infection and mortality odds compared to Whites. Some state-wide studies conducted in the early months of the pandemic found no in-hospital racial disparities in mortality.

METHODS

We performed chi-square and logistic regression analyses on the CDC COVID-19 Case Surveillance Restricted Database. The primary outcome of the study was all-cause in-hospital mortality. The primary exposures were racial group (White, Black, Hispanic and Others) and neighborhood type (low vulnerability, moderate vulnerability, high vulnerability, very high vulnerability).

FINDINGS

The overall unadjusted mortality rate was 33% and was lowest among Hispanics. In the fully adjusted models, Blacks and Hispanics had higher overall odds of dying [OR of 1.20 (95% CI 1.15, 1.25) and 1.23 (95% CI 1.17, 1.28) respectively] compared with White patients, and patients from neighborhoods with very high vulnerability had the highest mortality odds in the Northeast, Midwest and overall [Adjusted OR 2.08 (95% CI 1.91, 2.26)]. In the Midwest, Blacks and Hispanics had higher odds of mortality compared with Whites, but this was not observed in other regions.

INTERPRETATION

Among hospitalized COVID-19 patients, Blacks and Hispanics were more likely to die compared to Whites in the Midwest. Patients from highly vulnerable neighborhoods also had the highest likelihood of death in the Northeast and Midwest. These results raise important questions on our efforts to curb healthcare disparities and structural racism in the healthcare setting.