SIIReN - System Integration & Innovation Research Network

Primary Health Care System


Population-based study aimed at determining the association of region of origin, and other individual-level and neighbourhood-level factors, with cervical cancer screening rates among immigrant women in Ontario, Canada

  • Aisha K. Lofters MD1,2,3,4
  • Rahim Moineddin PhD1,5,6
  • Stephen W. Hwang MD3,7
  • Richard H. Glazier MD1,2,3,5,6
  1. Department of Family & Community Medicine, University of Toronto, Toronto, Canada
  2. Department of Family & Community Medicine, St. Michael’s Hospital, Toronto, Canada
  3. Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
  4. Primary Health Care System Research Fellow, London, Canada
  5. Institute for Clinical Evaluative Sciences, Toronto, Canada
  6. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
  7. Department of Medicine, University of Toronto, Toronto, Canada


Disparities in cervical cancer screening are known to exist in Ontario, Canada for foreign-born women. The relative importance of various barriers to screening may vary across ethnic groups. This study aimed to determine how predictors of low attendance at cervical cancer screening reflective of sociodemographics, the health care system, and migration varied by region of origin for Ontario’s immigrant women.


Using a validated billing code algorithm, we determined the proportion of women who were not screened during the three-year period of 2006-2008 among 455 864 identified immigrant women living in Ontario’s centres. We created eight identical multivariate Poisson models, stratified by eight regions of origin for immigrant women. In these models, we adjusted for various sociodemographic, health care-related and migration-related variables. We then used the resulting adjusted relative risks to calculate population-attributable fractions for each variable by region of origin.


Region of origin was not a significant source of effect modification for lack of recent cervical cancer screening. Certain variables were significantly associated with lack of screening across all or nearly all world regions. These consisted of not being in the 35-49 year age group, living in the lowest-income neighbourhoods, not being in a primary care patient enrolment model, a provider from the same region, and not having a female provider. For all women, the highest population-attributable risk was seen for having not having a female provider, with values ranging from 16.8% [95% CI 14.6-19.1%] among women from the Middle East and North Africa to 27.4% [95% CI 26.2-28.6%] for women from East Asia and the Pacific.


To increase screening rates across immigrant groups, efforts should be made to ensure that women have access to a regular source of primary care, and ideally access to a female health professional. Efforts should also be made to increase the enrolment of immigrant women in new primary care patient enrolment models.


For further information and/or a copy of the full report, please contact:
Dr. Aisha Lofters

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