Trends in utilization of cervical cancer screening and screening-associated services in a multi-organizational research network in Chicago, Illinois, US

PURPOSE: Chicago has a high degree of care fragmentation, with multiple large health systems and numerous safety-net systems. Fragmentation may be why the west and south areas of Chicago have high incidences of cervical cancer despite high self-reported screening rates. This study assesses utilization of cervical cancer screening-associated tests and procedures across seven health systems in Chicago between 2012 and 2022. METHODS: This retrospective cohort study included females aged 15+ years enrolled in one or more health systems in the CAPriCORN network. Data were analyzed with descriptive statistics, geolocation, linear mixed-effects model, and Poisson regression. Proportions and trends in utilization by year of test modalities (cytology alone, cytology and human papillomavirus (HPV) test [cotest], HPV test alone, colposcopy, and cervical procedures [cone biopsy, loop electrosurgical excision procedure, and ablation]) were calculated and stratified by Chicago's six geographic zones. The time between screening utilization was compared by age, Chicago zone, and change in health system. RESULTS: Of 1.20 million in the study cohort, 53.6% had only 1 screening test during the 11-year study period; 22.9% had 2 tests, and 22.9% had 3 or more. Individuals in Chicago who changed health systems between two consecutive screening tests had a longer median interval between tests compared with those who did not change (34 versus 15.4 months). CONCLUSIONS: Over half of the cohort only had one screening test and may be underscreened. Switching health systems more than doubled the time interval between screening tests compared with patients who remained in the same system.