Cervical Cancer Screening Rates by Race and Ethnicity, Age, Language, and Census Region

Importance: Longitudinal evidence of cervical cancer screening (CCS) trends before and after COVID-19 across demographic cohorts remains limited. Objective: To examine CCS rates by race and ethnicity, age, language, and census region among patients with at least 1 health care encounter in an electronic medical record (EMR) system from 2019 through 2024, and to evaluate longitudinal trends across these groups. Design, Setting, and Participants: Using an EMR database, this cross-sectional study evaluated CCS rates among female patients aged 21 to 64 years between 2019 and 2024, stratified by race and ethnicity, age, language, and census region. Exposures: Race and ethnicity, age, language, and census region. Main Outcomes and Measures: Descriptive statistics were used to summarize annual CCS rates across demographic groups. The Cochran-Armitage test assessed linear trends over time. Results: Annual sample sizes ranged from approximately 9 to 16 million patients and increased steadily over time; analytic population sizes varied across subgroups. Most patients were non-Hispanic White, aged 30 to 49 years, English-speaking, and resided in either the South or Northeast. Non-Hispanic White patients had the highest annual CCS rates from 2019 to 2021 but experienced the smallest percentage increase, from 10.98% (95% CI, 10.96%-11.01%) to 13.85% (95% CI, 13.82%-13.87%), over the study period. Hispanic patients experienced the largest percentage increase in CCS rates, from 9.85% (95% CI, 9.80%-9.90%) to 15.51% (95% CI, 15.47%-15.55%). American Indian, Alaska Native, Native Hawaiian, and Pacific Islander patients had the lowest screening rates throughout the study period. Patients aged 30 to 49 years and non-English-speaking patients consistently had the highest CCS rates across all years. Patients in the Western and Southern census regions had lower CCS rates than those in other regions. Conclusions and Relevance: In this cross-sectional study of patients with at least 1 health care encounter in an EMR system, all CCS rates increased across all racial and ethnic groups from 2019 to 2024, with the greatest gains observed among Hispanic patients. However, persistent disparities remained, particularly among American Indian, Alaska Native, Native Hawaiian, and Pacific Islander patients and those in the Western and Southern regions. These findings suggest that although screening uptake has improved over time, substantial geographic and racial and ethnic disparities in CCS persist, highlighting important areas for future research and intervention efforts.