Women's compliance with public health guidelines for mammograms and Pap tests in Canada and the United States - An analysis of data from the Joint Canada/United States Survey of Health

Objectives. We use the joint Canada/United States Survey of Health (JCUSH) to examine use of mammograms and Pap tests among Canadian and US women during 2002 and 2003. Unlike previous data, the JCUSH data are bi-nationally comparable, in that the same instrument was used for interviewing both Canadian and US respondents at the same time. Furthermore, when appropriately weighted, these data are representative of the populations of both countries. Methods. Descriptive statistics were used to provide a basic profile of screening practices among women in Canada and the United States. Logistic regression was then used to examine the determinants of compliance with mammogram and Pap test guidelines in the 2 countries, statistically controlling for demographic and socioeconomic characteristics, health status, and other indicators suggested from previous research. To increase comparability, these analyses were restricted to the age ranges covered in common by the screening guidelines of both countries. Results. Among women covered by the guidelines in both countries, screening rates were higher in the United States than in Canada at all ages, which is puzzling given the existence of Canada's universal health care system. Multivariate analyses revealed that whether a woman had had a mammogram within the last 2 years (when predicting last Pap test) or had had a Pap test within the last 3 years (when predicting last mammogram) were the strongest and most consistent predictors of compliance in both countries. Race/ethnicity, nativity, marital status, socioeconomic status, insurance coverage in the United States, and various health status indicators also predicted compliance in some, but not all, models.