Cervical cancer risk and access: Utilizing three statistical tools to assess Haitian women in South Florida

• Published in: PloS one Vol. 16; no. 7; p. e0254089
• Main Authors: Moise, Rhoda K, Balise, Raymond, Ragin, Camille, Kobetz, Erin
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 06-07-2021; Public Library of Science (PLoS)
• Subjects: Access; Algorithms; Biology and Life Sciences; Cancer; Cervical cancer; Cervix; Citizenship; Classification; Clinical trials; Colonialism; Data analysis; Decision Trees; Disease; Education; Evaluation; Female; Florida - epidemiology; Haiti; Health aspects; Health behavior; Health care policy; Health policy; Health risks; Health sciences; Health Services Accessibility; Health services utilization; Humans; Immigrants; Immigration; Immigration policy; Logistic Models; Medical screening; Medicine and Health Sciences; Middle Aged; Multivariate Analysis; Noncitizens; Population studies; Public health; Racism; Regression analysis; Risk assessment; Risk Factors; Sexism; Social Sciences; Sociodemographics; Statistical analysis; Statistics as Topic; Success; Tests; Undocumented immigrants; Uterine Cervical Neoplasms - epidemiology; Variables; Violence; Women; Womens health; Xenophobia; Florida; Haiti; United States; South Florida; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0254089

Although decreasing rates of cervical cancer in the U.S. are attributable to health policy, immigrant women, particularly Haitians, experience disproportionate disease burden related to delayed detection and treatment. However, risk prediction and dynamics of access remain largely underexplored and unresolved in this population. This study seeks to assess cervical cancer risk and access of unscreened Haitian women. Extracted and merged from two studies, this sample includes n = 346 at-risk Haitian women in South Florida, the largest U.S. enclave of Haitians (ages 30-65 and unscreened in the previous three years). Three approaches (logistic regression [LR]; classification and regression trees [CART]; and random forest [RF]) were employed to assess the association between screening history and sociodemographic variables. LR results indicated women who reported US citizenship (OR = 3.22, 95% CI = 1.52-6.84), access to routine care (OR = 2.11, 95%CI = 1.04-4.30), and spent more years in the US (OR = 1.01, 95%CI = 1.00-1.03) were significantly more likely to report previous screening. CART results returned an accuracy of 0.75 with a tree initially splitting on women who were not citizens, then on 43 or fewer years in the U.S., and without access to routine care. RF model identified U.S. years, citizenship, and access to routine care as variables of highest importance indicated by greatest mean decreases in Gini index. The model was .79 accurate (95% CI = 0.74-0.84). This multi-pronged analysis identifies previously undocumented barriers to health screening for Haitian women. Recent US immigrants without citizenship or perceived access to routine care may be at higher risk for disease due to barriers in accessing U.S. health-systems.