Distribution and Correlates of Cervical Pap Smear Screening Rates in Taiwan : An Ecological Study

• Main Authors: CHIN-LAN JEN, 任金蘭
• Other Authors: CHIEN-AN SUN
• Format: Others
• Language: zh-TW
• Published: 2000
• Online Access: http://ndltd.ncl.edu.tw/handle/94451490609853859130

碩士 === 國防醫學院 === 公共衛生學研究所 === 88 === Invasive cervical cancer is the most common cancer in women. Nevertheless, early detection of cervical cancer and its precursor lesions by Papanicolaou (Pap) smears has been shown to be effective in reducing incidence of and mortality from invasive cervical cancer in industrialized nations. Moreover, several studies have shown that the degree to which cervical cancer incidence rates fall in a population is related to the percentage of the population that has been screened and the length of the screening interval. Indeed, cervical cancer is also the most common cancer in women in Taiwan and an annual Pap smear screening service has been provided to women age 30 years and older nation-wide since 1995. It is important to examine the rates and correlates of Pap smear screening at nation-wide level. Accordingly, this study was undertaken with an ecological study approach to analyze coverage rates and correlates of Pap smear screening in Taiwan. This study utilized the cervical screening database, which was established by the Department of Health in 1994. Data used in the analysis was derived from the database relevant to women aged between 30 and 69 years old from 1996 to 1998. The woman-time of Pap smears taken for target women from 1996 to 1998 was 1027784, 1363694 and 1712780, respectively. The corresponding number of women undergoing screening was 959967, 1262647 and 1568306, respectively. A total of 359 administrative regions including 12 districts in Taipei City, 11 districts in Kaohsiung City and 336 townships and precincts of Taiwan Province were used as study units. Data of explanatory variables including number of currently married women, population density, crude birth rates, general fertility rates, total fertility rates, total movement rates for women, registered nurses per health station, number of Pap smear taken per health station and number of contracted hospitals and clinics for Pap smear examination were obtained from officially published data. Age-adjusted Pap smear screening rates were calculated to compare differences in screening rates among administrative units. In addition, linear regression model was used to analyze correlates of variations of screening rates among administrative units. The study results showed that Pap smear screening rates increased over time in Taiwan. In addition, screening rates decreased with advancing age from 49.4% in women aged 30-34 years to 27.6% in those aged 65-69 years. Furthermore, the highest rate was found in aboriginal hsiangs (43.5%) and the lowest rate was observed in cities under the administration of Taiwan Province (36.25%) when age adjustment was made. Results obtained from linear regression analyses revealed that number of Pap smear examination performed by health station professional personnels was positively associated with screening rates while total movement rates for women was negatively related to screening rates among administrative units. In summary, this study is the first study to examine Pap smear screening rates and factors attributable to variations in screening rates at aggregate level in a defined area. The study results may provide useful data for administrative monitoring and evaluation of the performance of Pap smear screening program.