Rural-Urban Differences in Cervical Cancer Screening Patterns: A Cross-Sectional Analysis of the 2021 National Health Interview Survey (NHIS).

BACKGROUND: Rural women in the United States experience cervical cancer disparities. This study investigates whether these disparities extend beyond cancer to include screening recency, modality, and patient awareness. METHODS: This cross-sectional analysis used 2021 NHIS data on N = 1463 rural and N = 9227 urban US women aged 21-65 to investigate associations between rurality and cervical cancer screening outcomes, including: ever having had cervical cancer screening, time since most recent screening, abnormal result in the past 5 years, being told the test type at most recent screening, Pap testing at most recent screening, and HPV testing at most recent screening. Weighted bivariate analyses compared unadjusted outcomes, and multivariable logistic regressions controlling for sociodemographic covariates estimated adjusted odds ratios (aORs) of outcomes between the two groups. RESULTS: In unadjusted analyses, rural women were less likely to report screening within the past 5 years (odds ratio [OR]: 0.82, 95% CI: 0.70 to 0.96) and more likely to report HPV testing at their most recent screening (OR: 1.60, 95% CI: 1.35 to 1.89). After adjustment for sociodemographic covariates, rural women remained less likely to report screening within the past 5 years (aOR 0.79, 95% CI: 0.67 to 0.92) and had higher adjusted odds of HPV testing at most recent screening (aOR: 1.41, 95% CI: 1.16 to 1.70). CONCLUSIONS: These results highlight persistent geographic disparities in cervical cancer screening recency, but also demonstrate potential improvement in HPV testing in rural areas.