Sarah M Peitzmeier1, Karishma Khullar2, Sari L Reisner3, Jennifer Potter4. 1. Fenway Institute, Harvard University, Boston, Massachusetts; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland. 2. Fenway Health, Harvard University, Boston, Massachusetts; University of Cincinnati College of Medicine, Cincinnati, Ohio. 3. Fenway Institute, Harvard University, Boston, Massachusetts; Harvard School of Public Health, Harvard University, Boston, Massachusetts. 4. Fenway Health, Harvard University, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts. Electronic address: jpotter@bidmc.harvard.edu.
Abstract
BACKGROUND: A paucity of empirical research to date has examined cervical cancer screening in female-to-male (FTM) transgender men who retain their natal reproductive structures compared to non-transgender women. PURPOSE: To examine patient and provider characteristics associated with being up-to-date on Pap tests, with a focus on gender identity and sexual orientation. METHODS: Retrospective chart review of 5,232 patients (4,882 women, 350 FTM transgender men) at an urban community health center. All HIV-negative primary care patients aged 21-64 years (inclusive) with at least one medical visit during the 2012 calendar year and who had a cervix as of December 31, 2012, were included. Data were analyzed in 2013 using a multilevel logistic regression model nesting patients within providers. RESULTS: FTM patients were significantly less likely to be up-to-date on Pap tests (AOR=0.63, 95% CI=0.47, 0.85) compared to non-transgender women, after adjusting for individual- and provider-level factors. Behaviorally bisexual patients, compared to patients who had sex with men exclusively, were more likely to be up-to-date (AOR=1.73, 95% CI=1.32, 2.26); patients reporting only sex with women were not significantly more or less likely to be up-to-date (AOR=1.01, 95% CI=0.83, 1.23). CONCLUSIONS: Transgender patients are not accessing the same level of preventive cervical screening care as non-transgender female patients. There is a need to better understand barriers to care in this population. Contrary to findings in other settings, history of sex with women was not negatively associated with Pap utilization.
BACKGROUND: A paucity of empirical research to date has examined cervical cancer screening in female-to-male (FTM) transgender men who retain their natal reproductive structures compared to non-transgender women. PURPOSE: To examine patient and provider characteristics associated with being up-to-date on Pap tests, with a focus on gender identity and sexual orientation. METHODS: Retrospective chart review of 5,232 patients (4,882 women, 350 FTM transgender men) at an urban community health center. All HIV-negative primary care patients aged 21-64 years (inclusive) with at least one medical visit during the 2012 calendar year and who had a cervix as of December 31, 2012, were included. Data were analyzed in 2013 using a multilevel logistic regression model nesting patients within providers. RESULTS: FTM patients were significantly less likely to be up-to-date on Pap tests (AOR=0.63, 95% CI=0.47, 0.85) compared to non-transgender women, after adjusting for individual- and provider-level factors. Behaviorally bisexual patients, compared to patients who had sex with men exclusively, were more likely to be up-to-date (AOR=1.73, 95% CI=1.32, 2.26); patients reporting only sex with women were not significantly more or less likely to be up-to-date (AOR=1.01, 95% CI=0.83, 1.23). CONCLUSIONS: Transgender patients are not accessing the same level of preventive cervical screening care as non-transgender female patients. There is a need to better understand barriers to care in this population. Contrary to findings in other settings, history of sex with women was not negatively associated with Pap utilization.
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Authors: Sari L Reisner; Renee K Randazzo; Jaclyn M White Hughto; Sarah Peitzmeier; L Zachary DuBois; Dana J Pardee; Elliot Marrow; Sarah McLean; Jennifer Potter Journal: Qual Health Res Date: 2017-05-04