# Factors associated with cervical cancer screening participation in Southwest China: a retrospective database-based cross-sectional study

## TL;DR

This study identifies factors influencing cervical cancer screening participation in Southwest China, highlighting the role of education, income, and healthcare access.

## Contribution

The study provides novel insights into the socioeconomic and healthcare-related factors affecting screening participation in a specific regional context.

## Key findings

- Higher education and income were independently associated with increased screening participation.
- Urban residence and medical insurance coverage strongly predicted screening participation.
- Shorter distance to healthcare facilities and non-smoking were positively linked to screening.

## Abstract

Cervical cancer remains a major public health concern in developing regions, including Southwest China, where population-based screening coverage remains limited. This study aimed to identify sociodemographic, behavioral, and healthcare-related factors associated with cervical cancer screening participation among women in this region through a retrospective, database-based cross-sectional analysis.

De-identified data from 2,320 women aged 20–65 years were retrospectively retrieved from institutional health information systems and standardized regional screening databases covering January–December 2023. Screening participation was defined as documentation of a Pap smear or HPV test within the preceding 3 years. Variables on demographic characteristics, health behaviors, and healthcare accessibility were analyzed using chi-squared tests, t-tests, and multivariable logistic regression. Subgroup analyses stratified by residence (urban vs. rural) and sensitivity analyses under alternative model assumptions were conducted to assess consistency and robustness. No new data were collected, and no direct participant contact occurred.

Younger age (adjusted odds ratio [aOR] = 0.96 per year; 95% confidence interval [CI]: 0.94–0.98), higher education (aOR = 2.30; 95% CI: 1.84–2.87), and higher income (aOR = 1.74; 95% CI: 1.44–2.11) were independently associated with greater screening participation. Urban residence (aOR = 2.13; 95% CI: 1.78–2.54), medical insurance coverage (aOR = 4.12; 95% CI: 3.19–5.33), and shorter distance to healthcare facilities (aOR = 0.39 for >15 km; 95% CI: 0.28–0.54) were also strongly associated with screening participation. Non-smoking and regular physical activity were positively associated with participation. Patterns were consistent across urban and rural subgroups, with no significant interaction effects.

This retrospective database analysis identified socioeconomic and healthcare accessibility disparities that were associated with cervical cancer screening participation in Southwest China. Targeted interventions that strengthen education, expand insurance coverage, and improve access to primary screening services are critical to increasing screening uptake and advancing cervical cancer prevention equity.