Does the Intersectionality of Race/Ethnicity and Type 2 Diabetes Increase the Odds of a Cervical Cancer Diagnosis? A Nested Case–Control Study of a Florida Statewide Multisite EHR Database

Abstract

Cervical cancer and Type 2 Diabetes (T2D) share common demographic risk factors. Despite this, scarce research has examined the relationship between race/ethnicity, having T2D, and cervical cancer incidence. We analyzed statewide electronic health records data between 2012 and 2019 from the OneFlorida+ Data Trust. We created a 1:4 nested case–control dataset. Each case (patient with cervical cancer) was matched with four controls (patients without cervical cancer) without replacement by year of encounter, diagnosis, and age. We used conditional logistic regression to estimate the unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to examine the association between race/ethnicity, T2D, and cervical cancer incidence. A total of 100,739 cases and 402,956 matched controls were identified. After adjusting for sociodemographic characteristics, non-Hispanic Black women with T2D had higher odds of cervical cancer compared with non-Hispanic White women with T2D (OR: 1.58, 95% CI 1.41–1.77). Living in a rural area, having Medicaid/Medicare insurance, and having high social vulnerability were associated with higher odds of having a cervical cancer diagnosis. Our findings imply the need to address the higher burden of cervical cancer diagnosis among non-Hispanic Black women with T2D and in underserved populations.

Acceptability of HPV self-collection: A qualitative study of Black women living with type II diabetes and social vulnerability

“…First, to our knowledge, this is the first research to focus on HPV self-collection preferences among Black women with social vulnerability and T2D. Cervical cancer mortality is disproportionately higher among Black women and women with high social vulnerability [18] . Moreover, diabetes is associated with poor prognosis for cervical cancer [24] .…”

“…Type 2 diabetes (T2D) is a risk factor that is associated with poor survival for cervical cancer, as highlighted in a systematic review published in 2017 [24] . Black women with T2D have 55 % higher odds of being diagnosed with cervical compared to white women with T2D [18] . Women living with T2D are less likely to receive cervical cancer screening [25] .…”

“…Disparities in cervical cancer mortality are exacerbated by social vulnerability [18] . The social vulnerability index is a census measure that quantifies level of external stressors including household characteristics, socioeconomic status, racial and minority status, and access to reliable transportation that disproportionately threaten communities’ ability to address health challenges [19] .…”

“…A 2021 study of women living in the southern U.S. found that women with T2D are significantly less likely to receive HPV testing compared to women without T2D [25] . According to a recent study using statewide clinical data in Florida, Black women living with diabetes have higher odds of being diagnosed with cervical cancer compared to White women living with diabetes [18] . Clinicians have shared that prioritizing the management of chronic medical diseases such as diabetes interferes with cervical cancer screening [27] .…”