JAMA network open · 2026
Multiple Dimensions of Social Vulnerability and Cervical Cancer Screening Uptake.
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Haury Julie, Chanier Jean Baptiste, Renevier Bruno, Canlorbe Geoffroy, Crequit Simon
Аннотация
IMPORTANCE: Despite organized screening programs, persistent social inequalities undermine cervical cancer screening effectiveness in high-income countries, disproportionately affecting the most socially vulnerable women.
OBJECTIVES: To identify distinct social vulnerability profiles among pregnant women and examine their associations with cervical cancer screening adherence and intraepithelial lesion detection.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study assessed all pregnant women 25 years or older who delivered at Centre Hospitalier Intercommunal André-Grégoire, a single tertiary care maternity unit in France, between May 1, 2019, and May 1, 2025.
EXPOSURES: Social vulnerability was assessed across 15 indicators spanning administrative, psychological, and violence-related domains. Multiple component analysis and hierarchical clustering on principal components identified 6 distinct vulnerability profiles. Multiple logistic regression examined associations between profiles and cervical screening inadequacy (no cervical sample within the last 3 years, including those never screened) and squamous intraepithelial lesion detection, adjusting for maternal age and body mass index.
MAIN OUTCOMES AND MEASURES: Cervical screening inadequacy (primary outcome) and low- and high-grade squamous intraepithelial lesion detection (secondary outcome).
RESULTS: Among 18 253 women (median [IQR] age, 32.3 [29.1-36.0] years; median [IQR] body mass index, 25.9 [22.7-29.4]), 10 248 (56.1%) were up to date with screening. Six vulnerability profiles were identified. Compared with the low-vulnerability reference profile, all profiles showed increased odds of screening inadequacy: substance use and psychological vulnerability (adjusted odds ratio [AOR], 1.33; 95% CI, 1.20-1.48), migrant or linguistic barrier (AOR, 3.40; 95% CI, 3.16-3.66), psychological violence (AOR, 2.01; 95% CI, 1.75-2.32), sexual violence (AOR, 2.08; 95% CI, 1.74-2.48), and physical violence (AOR, 2.54; 95% CI, 2.19-2.95). Violence-exposed and substance use profiles also had significantly higher proportions of women with a detected intraepithelial lesion despite reduced screening participation.
CONCLUSIONS AND RELEVANCE: In this cohort study of pregnant women, distinct social vulnerability profiles were differentially associated with cervical cancer screening inadequacy; women with migration-related barriers experienced the greatest disadvantage, and violence-exposed women showed both reduced screening and elevated disease burden. These findings suggest profile-specific interventions could help reduce cervical cancer screening inequalities among socially vulnerable populations.
OBJECTIVES: To identify distinct social vulnerability profiles among pregnant women and examine their associations with cervical cancer screening adherence and intraepithelial lesion detection.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study assessed all pregnant women 25 years or older who delivered at Centre Hospitalier Intercommunal André-Grégoire, a single tertiary care maternity unit in France, between May 1, 2019, and May 1, 2025.
EXPOSURES: Social vulnerability was assessed across 15 indicators spanning administrative, psychological, and violence-related domains. Multiple component analysis and hierarchical clustering on principal components identified 6 distinct vulnerability profiles. Multiple logistic regression examined associations between profiles and cervical screening inadequacy (no cervical sample within the last 3 years, including those never screened) and squamous intraepithelial lesion detection, adjusting for maternal age and body mass index.
MAIN OUTCOMES AND MEASURES: Cervical screening inadequacy (primary outcome) and low- and high-grade squamous intraepithelial lesion detection (secondary outcome).
RESULTS: Among 18 253 women (median [IQR] age, 32.3 [29.1-36.0] years; median [IQR] body mass index, 25.9 [22.7-29.4]), 10 248 (56.1%) were up to date with screening. Six vulnerability profiles were identified. Compared with the low-vulnerability reference profile, all profiles showed increased odds of screening inadequacy: substance use and psychological vulnerability (adjusted odds ratio [AOR], 1.33; 95% CI, 1.20-1.48), migrant or linguistic barrier (AOR, 3.40; 95% CI, 3.16-3.66), psychological violence (AOR, 2.01; 95% CI, 1.75-2.32), sexual violence (AOR, 2.08; 95% CI, 1.74-2.48), and physical violence (AOR, 2.54; 95% CI, 2.19-2.95). Violence-exposed and substance use profiles also had significantly higher proportions of women with a detected intraepithelial lesion despite reduced screening participation.
CONCLUSIONS AND RELEVANCE: In this cohort study of pregnant women, distinct social vulnerability profiles were differentially associated with cervical cancer screening inadequacy; women with migration-related barriers experienced the greatest disadvantage, and violence-exposed women showed both reduced screening and elevated disease burden. These findings suggest profile-specific interventions could help reduce cervical cancer screening inequalities among socially vulnerable populations.