Papanicolaou Test Rates Among Sexual Minority Women: A Systematic Review and Meta-Analysis

Purpose: The purpose of this review was to compare differences in Papanicolaou (pap) test rates between sexual minority women (SMW) and heterosexual women. Methods: PubMed, Embase, and Scopus were searched from inception until June 2020 for articles reporting pap test rates among SMW. Studies were selected if they included pap test rates for SMW with a comparison rate for heterosexual women; studies were excluded if they did not report pap test rates. A quality assessment scale was used to assess study quality. A random-effects model was employed to calculate pooled odds ratios (ORs) for each outcome along with 95% confidence intervals (CI). Heterogeneity was assessed by implementation of the I-2 statistic, and L'Abbe plots were inspected visually to assess for homogeneity. Sensitivity analyses were performed by omitting each study sequentially and analyzing the overall impact of that study on the pooled results. Meta-regression was conducted to identify potential causes of heterogeneity among any statistically significant outcomes by an examination of the covariable of insurance coverage. Results: We identified 21 cross-sectional studies comprising 24,207 SMW and 546,259 heterosexual women that met inclusion criteria. Overall, studies were of a fair quality. When compared with heterosexual women, SMW received less frequent pap tests (OR 0.58, 95% CI 0.48-0.71, 21 studies, 24,207 SMW, 546,259 heterosexual women). Compared with heterosexual women, lesbian women had routine pap tests less frequently (OR 0.46, 95% CI 0.37-0.56, 17 studies, 9595 lesbian women and 516,760 heterosexual women). Meta-regression for insurance status did not alter these results. Conclusion: SMW, in general, and lesbian women, in particular, receive pap tests less frequently than heterosexual women. The reasons for this disparity should be investigated to better serve the needs of this population. PROSPERO Registration: CRD#42020191887