Date of Conferral

2016

Degree

Doctor of Public Health (DrPH)

School

Public Health

Advisor

Namgyal Kyulo

Abstract

Cervical cancer represents a significant public health problem in the United States. According to the Centers for Disease Control and Prevention, the prognosis is related to stage at diagnosis, with the 5-year survival rate being 91.2% for early stage disease and only 17.0% for those with late stage disease. There is a gap in the literature examining the association of insurance status with late stage cervical cancer diagnosis across a large segment of the United States population. There is also a gap in the literature examining women residing in the United States with late stage cervical cancer diagnosis and identifying their country of birth. Guided by Andersen's behavioral model of healthcare utilization, this study used the Surveillance, Epidemiology, and End Results database, which includes over 28% of the United States population. The independent variables used were insurance, country of birth, race/ethnicity, age at diagnosis, and marital status. The dependent variable was stage at diagnosis. This cross sectional study included data from 7,445 women across the United States for the years 2008-2012. Two-way tests of association and logistic regression were used to analyze the data. The logistic regression (full model) was statistically significant and found that women born outside of the United States have a lower risk of late stage cervical cancer diagnosis and that unmarried women have a greater risk of late stage diagnosis. This study should send a signal to healthcare providers, as well as public health organizations, to direct their actions toward targeting groups that are now being diagnosed with late stage disease.

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