| Summary: | 碩士 === 國立成功大學 === 公共衛生研究所 === 101 === Pap smear is effective to prevent invasive cervical cancer. WHO suggests that nations should provide Pap smear to nationals, in order to reduce invasive cervical cancer. Taiwan government provided free Pap smear to avert economical threshold since 1995. This policy expected that everyone could use Pap smear, then promote the people health, and decrease socioeconomic inequality. But, little study explore the health effect of this policy among different socioeconomic strata women. This study would explore how individual and area socioeconomic status affect Pap smear and invasive cervical cancer incident with national based free cervical cancer screening program. Then took Pap smear into account when analyzed individual and area socioeconomic differences among invasive cervical cancer survival.
Data included the 2000-2010 National Health Insurance (NHI) and statistics of causes of death which sources from The Collaboration Center of Health Information Application (CCHIA). People divided into individual socioeconomic strata and area socioeconomic strata, make use of descriptive statistics, long-term trend analysis, logistic regression and Cox proportional hazards model to analysis Pap screen rate and invasive cervical cancer incident rate among females over 30 years old with different socioeconomic strata. Furthermore, explore invasive cervical cancer survival among different socioeconomic strata females, after adjusted individual and area socioeconomic status and Pap smear.
Study result show that low individual socioeconomic status has low Pap screen rate, and high invasive cervical cancer incident rate. Furthermore, low area socioeconomic status has high Pap screen rate, but invasive cervical cancer incident rate was still high. Invasive cervical cancer survival analysis detected that Pap smear before invasive cervical cancer was a significant protect factor. After adjusted age and Pap smear before invasive cervical cancer, invasive cervical cancer survival became no difference among area socioeconomic strata, but low individual socioeconomic females still has significant high death risk.
In the past, study explored invasive cervical cancer survival without taking Pap smear into account, so study couldn’t explore how Pap smear affect invasive cervical cancer survival. This study took Pap smear into account when analysis invasive cervical cancer survival. Study revealed that even under free Pap smear without economic threshold, low individual socioeconomic females still has low Pap smear using, and has high invasive cervical cancer incident and death risk. Although Pap smear has protect effect to invasive cervical cancer patients, the same Pap screen practice still couldn’t achieve equal among invasive cervical cancer survival. If this mechanism couldn’t be unraveled, it could weaken Pap screen in order to early detect and early treat, and weaken free Pap screen in order to reduce socioeconomic health inequality.
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