Table 3.
Adjusted* odds of cervical cancer screening adherence after receiving a birthday letter compared to a Pap-specific letter, stratified by up-to-date and overdue status, and by risk factors from 2003–2012 in Washington state.
| Number of prevention recommendations in the birthday letter | ||||||
|---|---|---|---|---|---|---|
| 1–2 recommendations | 3–5 recommendations | 6–7 recommendations | ||||
| OR* | 95% CI | OR* | 95% CI | OR* | 95% CI | |
| Up-to-date women: Overall results | ||||||
| N=33,984 | N=30,050 | N=3,375 | ||||
| Pap-specific letter N=30,474 (reference) |
1.00 | 1.00 | 1.00 | |||
| Birthday letter | 0.37 | (0.36, 0.39) | 0.44 | (0.42, 0.45) | 0.36 | (0.32, 0.40) |
| Stratified by group (reference=Pap-specific letter for each model)** | ||||||
| Age: 21–30 | 0.49 | (0.44, 0.55) | 0.69 | (0.37, 1.27) | 1.68 | (0.11, 26.91) |
| Age: 31–40 | 0.42 | (0.39, 0.45) | 0.33 | (0.23, 0.48) | 0.31 | (0.19, 0.52) |
| Age: 41–50 | 0.39 | (0.37, 0.42) | 0.41 | (0.38, 0.45) | 0.33 | (0.27, 0.42) |
| Age: 51–64 | 0.52 | (0.38, 0.70) | 0.39 | (0.37, 0.41) | 0.33 | (0.29, 0.37) |
| Preventive care waiver: Yes | 0.38 | (0.36, 0.40) | 0.45 | (0.43, 0.47) | 0.37 | (0.33, 0.41) |
| Preventive care waiver: No | 0.35 | (0.32, 0.37) | 0.40 | (0.37, 0.43) | 0.33 | (0.26, 0.41) |
| Deductible ≥$500: Yes | 0.36 | (0.32, 0.40) | 0.47 | (0.42, 0.52) | 0.40 | (0.30, 0.54) |
| Deductible ≥$500: No | 0.38 | (0.36, 0.39) | 0.43 | (0.42, 0.45) | 0.35 | (0.32, 0.40) |
| Charlson score: 1+ | 0.42 | (0.38, 0.47) | 0.51 | (0.46, 0.56) | 0.39 | (0.35, 0.44) |
| Charlson score: 0 | 0.37 | (0.35, 0.38) | 0.43 | (0.41, 0.45) | 0.34 | (0.24, 0.46) |
| 1+ healthcare visit: Yes | 0.37 | (0.35, 0.38) | 0.44 | (0.42, 0.46) | 0.36 | (0.32, 0.40) |
| 1+ healthcare visit: No | 0.38 | (0.36, 0.41) | 0.44 | (0.41, 0.47) | 0.31 | (0.23, 0.42) |
| Overdue women: Overall results | ||||||
| N=15,422 | N=15,212 | N=2,175 | ||||
| Pap-specific letter N=42,141 (reference) |
1.00 | 1.00 | 1.00 | |||
| Birthday letter | 0.99 | (0.95, 1.04) | 0.96 | (0.91, 1.00) | 0.95 | (0.85, 1.06) |
| Stratified by group (reference=Pap-specific letter for each model)** | ||||||
| Age: 21–30 | 0.95 | (0.86, 1.05) | 0.75 | (0.33, 1.72) | 0.75 | (0.33, 1.72) |
| Age: 31–40 | 1.06 | (0.97, 1.15) | 0.66 | (0.40, 1.07) | 1.02 | (0.51, 2.05) |
| Age: 41–50 | 1.04 | (0.96, 1.13) | 1.00 | (0.89, 1.13) | 0.99 | (0.78, 1.25) |
| Age: 51–64 | 1.24 | (0.82, 1.87) | 0.93 | (0.88, 0.99) | 0.91 | (0.80, 1.03) |
| Preventive care waiver: Yes | 1.00 | (0.95, 1.05) | 0.97 | (0.92, 1.02) | 0.97 | (0.86, 1.09) |
| Preventive care waiver: No | 0.94 | (0.85, 1.05) | 0.87 | (0.77, 0.99) | 0.83 | (0.61, 1.12) |
| Deductible ≥$500: Yes | 0.88 | (0.79, 0.99) | 0.91 | (0.81, 1.02) | 0.80 | (0.59, 1.08) |
| Deductible ≥$500: No | 1.04 | (0.99, 1.10) | 0.99 | (0.94, 1.04) | 0.98 | (0.87, 1.10) |
| Charlson score: 1+ | 1.17 | (0.99, 1.38) | 1.20 | (1.06, 1.35) | 0.99 | (0.87, 1.13) |
| Charlson score: 0 | 0.98 | (0.93, 1.02) | 0.93 | (0.88, 0.97) | 0.97 | (0.72, 1.31) |
| 1+ healthcare visit: Yes | 0.98 | (0.92, 1.04) | 1.00 | (0.94, 1.07) | 0.80 | (0.70, 0.90) |
| 1+ healthcare visit: No | 1.10 | (1.03, 1.17) | 0.99 | (0.92, 1.06) | 1.08 | (0.85, 1.38) |
*
Adjusted for age, ≥$500 deductible plan, preventive care waiver, Charlson score, and number of healthcare visits in the 12 months prior to receiving the letter.
**
The reference for each stratified model is the Pap-specific letter for the same group. For example, the row “Age: 21–30” compares the birthday letter to the Pap-specific letter among women aged 21–30 only. The row “Age: 31–40” compares the birthday letter to the Pap-specific letter among women aged 31–40 only.