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Background <p>Cervical cancer is preventable, yet India accounts for a disproportionate share of global cervical cancer deaths. National evidence on cervical cancer screening coverage and the factors associated with screening uptake among older women, who face elevated cervical cancer risk, is limited.</p> Methods <p>We conducted a cross-sectional study using nationally representative data from 35,481 women aged 45 years and above in Wave 1 of the Longitudinal Ageing Study in India (LASI, 2017–18). Pap smear testing in the past two years was examined using survey-weighted prevalence estimates and Firth’s penalized logistic regression to identify demographic, socioeconomic, healthcare, health status, behavioural, and geographic correlates.</p> Results <p>Only 1.31% (95% CI: 1.19–1.43) of women reported Pap smear testing in the past two years. Screening prevalence declined with age (from 1.72% among women aged 45–54 years to 0.51% among those aged ≥ 75 years) and was lower among widowed women (0.72% vs. 1.60% among married), rural residents (0.86% vs. 2.05% among urban), and women with no or low education (0.98% vs. 3.53% among graduates). Although 75.7% reported recent healthcare contact, screening uptake remained low even among these women (1.50%). Screening prevalence was highest in southern states (1.99%) and lowest in high-burden northern and central states (&lt; 1%), indicating an inverse care pattern. In fully adjusted models, recent health system contact (Adjusted Odds Ratio (AOR) 1.87, 95% CI 1.42–2.48), multimorbidity (≥ 2 chronic conditions; AOR 2.22, 95% CI 1.74–2.83), urban residence (AOR 1.81, 95% CI 1.47–2.24), and higher education (graduate; AOR 1.96, 95% CI 1.33–2.88) were strongly associated with recent Pap smear testing. </p> Conclusion <p>Cervical cancer screening coverage among older Indian women is extremely low despite widespread healthcare contact. The findings suggest substantial missed opportunities to deliver preventive care during routine encounters. Improving coverage will require stronger integration of screening into routine services and more organized, equity-focused screening programmes.</p>

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Disparities in cervical cancer screening among Indian women aged 45 years and older

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月9日

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  • Aditya Singh

摘要

Background

Cervical cancer is preventable, yet India accounts for a disproportionate share of global cervical cancer deaths. National evidence on cervical cancer screening coverage and the factors associated with screening uptake among older women, who face elevated cervical cancer risk, is limited.

Methods

We conducted a cross-sectional study using nationally representative data from 35,481 women aged 45 years and above in Wave 1 of the Longitudinal Ageing Study in India (LASI, 2017–18). Pap smear testing in the past two years was examined using survey-weighted prevalence estimates and Firth’s penalized logistic regression to identify demographic, socioeconomic, healthcare, health status, behavioural, and geographic correlates.

Results

Only 1.31% (95% CI: 1.19–1.43) of women reported Pap smear testing in the past two years. Screening prevalence declined with age (from 1.72% among women aged 45–54 years to 0.51% among those aged ≥ 75 years) and was lower among widowed women (0.72% vs. 1.60% among married), rural residents (0.86% vs. 2.05% among urban), and women with no or low education (0.98% vs. 3.53% among graduates). Although 75.7% reported recent healthcare contact, screening uptake remained low even among these women (1.50%). Screening prevalence was highest in southern states (1.99%) and lowest in high-burden northern and central states (< 1%), indicating an inverse care pattern. In fully adjusted models, recent health system contact (Adjusted Odds Ratio (AOR) 1.87, 95% CI 1.42–2.48), multimorbidity (≥ 2 chronic conditions; AOR 2.22, 95% CI 1.74–2.83), urban residence (AOR 1.81, 95% CI 1.47–2.24), and higher education (graduate; AOR 1.96, 95% CI 1.33–2.88) were strongly associated with recent Pap smear testing.

Conclusion

Cervical cancer screening coverage among older Indian women is extremely low despite widespread healthcare contact. The findings suggest substantial missed opportunities to deliver preventive care during routine encounters. Improving coverage will require stronger integration of screening into routine services and more organized, equity-focused screening programmes.