CERVICAL CANCER INEQUITIES IN COLOMBIA

Cervical cancer (CC) is the second most common cancer and third in cancer-related deaths among women. Developing countries account for most CC-related deaths and are highly impacted by CC mortality in young women. In South America, CC is the second most incident cause of cancer and first cause of cancer deaths among women 15-44 years. In Colombia, CC is the second most common cause of cancer mortality among women. Previous studies conducted in Colombia have shown inequities in CC prevention and mortality by different socio- demographic factors; however, there is a lack of nationwide studies evaluating these factors specifically in young Colombian women. The goal of this thesis was to identify socio-demographic characteristics associated with awareness of CC primary prevention, access to secondary prevention for CC, and CC mortality among young women in Colombia. The educational level, type of health insurance, having a rural or urban residence, and region of residence of women were common factors related to inequities in CC prevention and mortality in Colombia. Women with limited or no education had a reduced probability of having heard of HPV vaccination, with differing effects of education by age and region of residence. In the case of Pap testing, having a rural residence decreased the odds of Pap testing compared to having an urban residence, with wider differences in the odds among women with limited-to-no education compared to those with higher education. Additionally, a higher prevalence of no education in the neighbourhood where women lived resulted in lower odds of Pap testing in both rural and urban areas, especially when comparing women with limited-to-no education to women with a secondary or higher education. Measured at the administrative divisions or department level, a high prevalence of no education was associated with a low prevalence of Pap testing, specifically for departments being at or above the national prevalence of women living in rural areas. Similarly, mortality rates were higher among women with limited or no education compared to women with higher education, observing wider differences in younger age groups. Having subsidised insurance and not having insurance were associated with a decreased awareness of HPV vaccination. The effect of type of health insurance on Pap testing varied by whether women had a rural or urban residence. Departments with higher prevalences of women with subsidised insurance were associated with not having heard of HPV vaccination and not having had a Pap test. No significant differences in CC mortality were observed between women with subsidised insurance and those with no insurance. Also, mortality rates for different types of health insurance varied for some age groups. Women living in rural areas had a reduced awareness of HPV vaccination with variations by regions. Having a rural residence also decreased the probability of having Pap testing, particularly in some regions of Colombia and among women with no insurance or subsidised health insurance. Furthermore, increments in the department percentage of women living in rural areas increased the risk ratio of having women who had not had a Pap test in departments classified as at or above the national prevalence of no education. In contrast, living in rural areas was associated with lower CC mortality rates. Women from the Amazon-Orinoquía region had high rates of CC mortality and were less likely to have heard of HPV vaccination and have had a Pap test. Several departments located in the Amazon-Orinoquía region and a few departments from the Pacific, and Atlantic regions (e.g. Chocó, Sucre, and La Guajira) had a high risk of women not having access to primary and secondary CC prevention, after accounting for other risk factors

The role of socio-demographic factors in premature cervical cancer mortality in Colombia

Abstract Background While cervical cancer (CC) is an important cause of premature mortality in Colombia, the impact of socio-demographic factors on CC mortality in young women is not well understood. The primary objective of this study was to identify differences in CC mortality among Colombian women aged 20–49 years associated with education, type of health insurance, urban or rural and region of residence, and to determine whether differences in mortality associated with education or insurance varied by age. Methods Cervical cancer deaths for 2005–2013 and risk factors were obtained from the National Administrative Department of Statistics. Populations at risk were calculated from age-stratified population projections and the 2010 National and Demographic Health Survey. Negative binomial regression models, stratified by age, were used to examine associations between socio-demographic factors and mortality rates and whether the effects of education and health insurance varied by age. Multiple imputation was used to examine the importance of missing data. Results Differences of CC mortality were identified among women with limited to no education compared to highly educated women, with the largest disparity in the youngest age group (IRR 26.8, 95 % CI 6.65–108). Differences in mortality associated with health insurance also varied based on age group. Women with contributory and special health insurance had lower mortality rates than women with subsidised or no health insurance, except in the youngest age group. No differences were observed between women with subsidised and those with no insurance in any age group. Mortality rates were high among women who resided in urban areas and in the Atlantic, Central, Pacific, and Amazon-Orinoquía regions of Colombia. Missing values in the mortality database did not impact the findings from this study. Conclusions Limited education was most strongly associated with premature CC mortality in the youngest women. Subsidised insurance did not appear to provide significant protection against CC mortality when compared to not having insurance, suggesting the need to examine diagnostic and treatment services available under the subsidised insurance plan. Our results could be used to target interventions to optimise the impact of resources to prevent premature mortality due to CC in Colombia

Factors associated with drinking and being satisfied with tap water in Indigenous communities in Saskatchewan, Canada

Previous studies have described concerns regarding tap water in Indigenous communities, yet there is little information on participants who report drinking their tap water and being satisfied with its quality. This study undertaken with members of 8 Indigenous communities in Saskatchewan, Canada, and identified factors associated with both the decision to drink tap water at home and being satisfied with its quality. We examined the importance of factors such as individual attributes, experiences, attitudes, household and community-based variables. Less than one-quarter of participants (23.4%) drank tap water and were satisfied with its quality. Individuals who did not boil tap water (odds ratio [OR] = 5.76, 95% confidence interval [CI] = 1.68–19.8), those who did not experience tap water odour (OR = 2.38, 95% CI = 1.26–4.50) and participants living in communities away from urban centres (OR = 2.74, 95% CI = 1.63–4.51) were more likely to drink and be satisfied with their tap water. Concerns about the environment had the most impact on community members aged 55+ years. Those not reporting concerns about environmental problems affecting water (OR = 11.4, 95% CI = 3.10–42.2) were much more likely to drink and be satisfied with their tap water. Programmes to improve water quality, reduce the need for boil water advisories and increase community confidence in the environment could improve tap water satisfaction and consumption

Predictors of having heard about human papillomavirus vaccination: Critical aspects for cervical cancer prevention among Colombian women

AbstractObjectivesTo determine whether the probability of having heard about human papillomavirus (HPV) vaccination differs by socio-demographic characteristics among Colombian women; and whether the effect of predictors of having heard about HPV vaccination varies by educational levels and rural/urban area of residence.MethodsData of 53,521 women aged 13–49 years were drawn from the 2010 Colombian National Demographic and Health Survey. Women were asked about aspects of their health and their socio-demographic characteristics. A logistic regression model was used to identify factors associated with having heard about HPV vaccination. Educational level and rural/urban area of residence of the women were tested as modifier effects of predictors.Results26.8% of the women had heard about HPV vaccination. The odds of having heard about HPV vaccination were lower among women: in low wealth quintiles, without health insurance, with subsidized health insurance, and those who had children (p<0.001). Although women in older age groups and with better education had higher probabilities of having heard about HPV vaccination, differences in these probabilities by age group were more evident among educated women compared to non-educated ones. Probability gaps between non-educated and highly educated women were wider in the Eastern region. Living in rural areas decreased the probability of having heard about HPV vaccination, although narrower rural/urban gaps were observed in the Atlantic and Amazon-Orinoquía regions.ConclusionsAlmost three quarters of the Colombian women had not heard about HPV vaccination, with variations by socio-demographic characteristics. Women in disadvantaged groups were less likely to have heard about HPV vaccination