Participation in the National Cervical Screening Program Among Women Who Gave Birth in New South Wales, Australia by Place of Maternal Birth: A Data Linkage Analysis.

Abstract

Objective: High participation rates in the National Cervical Screening Program (NCSP) by all groups of women are required to ensure the equitable elimination of cervical cancer in Australia. In this study, we examine screening participation of overseas-born women compared to Australian-born women who gave birth.

Design: Population-based retrospective cohort study using linked health datasets.

Setting and participants: Women who gave birth in New South Wales between January 1, 2000 and June 30, 2017.

Main outcome measures: Participation in the NCSP (≥ 1 cytology test) in the 3- and 5-year periods prior to delivery by place of maternal birth, adjusted for multiple socio-demographic and health characteristics.

Results: Among the 1 332 669 mothers who gave birth over the study period, overall cervical screening participation in the 3- and 5-year periods prior to delivery was 67.0% and 75.7%, respectively. Participation was lower for overseas-born mothers compared to Australian-born mothers for both the 3-year (57.8% vs. 71.7%; adjusted odds ratio [aOR]: 0.51, 95% confidence interval [CI]: 0.50-0.51) and 5-year (64.9% vs. 81.2%; aOR: 0.40, 95% CI: 0.40-0.40) participation periods. All groups of overseas-born women had substantially lower screening participation compared to Australian-born women, with the lowest relative 3-year participation in mothers born in Southern/Central Asia (aOR: 0.30, 95% CI: 0.30-0.31), Oceania (aOR: 0.31, 95% CI: 0.30-0.32), North-East Asia (aOR: 0.49, 95% CI: 0.48-0.50), and New Zealand (aOR: 0.49, 95% CI: 0.48-0.51).

Conclusions: Overseas-born women had around half the cervical screening participation in the period prior to birth compared to Australian-born women. It is likely that opportunities to screen these under-screened groups during the antenatal period, typically a time of repeated health services contact, are missed.