抹片篩檢是子宮頸侵襲癌的有效預防方式，WHO也建議國家應提供國人抹片篩檢的服務，以降低罹患子宮頸侵襲癌的風險。我國於1995年起推行公費抹片篩檢，消弭抹片篩檢的經濟門檻，以期全民皆能使用抹片篩檢服務，進而達到增進全民健康、降低社經健康不平等的目的，但國內少有該介入對不同社經地位婦女健康效應的探討。因此，本研究欲探討在我國公費抹片篩檢政策之下，個人社經地位與地區社經地位對子宮頸抹片篩檢與子宮頸侵襲癌發生率的影響。並在考量抹片篩檢的情境下，分析我國子宮頸侵襲癌患者存活的個人社經與地區社經差異。
本研究資料來源為統計室健康資料加值中心，2000-2010年的全民健保資料庫與死因統計資料。區分個人與地區社經地位後，透過描述性統計、長期趨勢、邏輯斯迴歸、以及Cox 迴歸模式等方法，分析30歲以上不同社經地位的婦女抹片篩檢率及子宮頸侵襲癌發生率，以及校正了個人、地區社經地位與篩檢習慣後，子宮頸侵襲癌存活的社經差異。
研究結果發現，個人社經弱勢者的抹片篩檢率較低，且子宮頸侵襲癌發生率較高；但社經地位較低的地區，子宮頸抹片篩檢率雖然較高，卻也有較高的子宮頸侵襲癌發生率。而透過子宮頸侵襲癌患者的存活分析發現，子宮頸侵襲癌診斷前三年的抹片篩檢行為，是顯著的保護因子，在控制了年齡與篩檢行為後，不同社經地位的地區已無存活差異，然而個人社經弱勢者仍具顯著較高的死亡風險。
過去研究在探討子宮頸侵襲癌的存活時，並未將抹片篩檢習慣納入分析，未能探討抹片篩檢對侵襲癌存活的影響。本研究將抹片篩檢納入侵襲癌的存活分析，研究發現，即便推行公費子宮頸抹片篩檢，消弭抹片的經濟門檻，低社經地位者的抹片使用仍較差，子宮頸侵襲癌的發生與死亡風險也較高。抹片篩檢雖然對侵襲癌的患者具有保護作用，但相似的篩檢習慣也無法讓子宮頸侵襲癌患者的存活達到平等。若不能找出其中機制，將削弱子宮頸抹片篩檢希望早期發現早期治療的公共衛生目的，也降低了公費抹片篩檢降低社經間健康不平等的美意。

Pap smear is effective to prevent invasive cervical cancer. WHO suggests that nations should provide Pap smear to nationals, in order to reduce invasive cervical cancer. Taiwan government provided free Pap smear to avert economical threshold since 1995. This policy expected that everyone could use Pap smear, then promote the people health, and decrease socioeconomic inequality. But, little study explore the health effect of this policy among different socioeconomic strata women. This study would explore how individual and area socioeconomic status affect Pap smear and invasive cervical cancer incident with national based free cervical cancer screening program. Then took Pap smear into account when analyzed individual and area socioeconomic differences among invasive cervical cancer survival.
Data included the 2000-2010 National Health Insurance (NHI) and statistics of causes of death which sources from The Collaboration Center of Health Information Application (CCHIA). People divided into individual socioeconomic strata and area socioeconomic strata, make use of descriptive statistics, long-term trend analysis, logistic regression and Cox proportional hazards model to analysis Pap screen rate and invasive cervical cancer incident rate among females over 30 years old with different socioeconomic strata. Furthermore, explore invasive cervical cancer survival among different socioeconomic strata females, after adjusted individual and area socioeconomic status and Pap smear.
Study result show that low individual socioeconomic status has low Pap screen rate, and high invasive cervical cancer incident rate. Furthermore, low area socioeconomic status has high Pap screen rate, but invasive cervical cancer incident rate was still high. Invasive cervical cancer survival analysis detected that Pap smear before invasive cervical cancer was a significant protect factor. After adjusted age and Pap smear before invasive cervical cancer, invasive cervical cancer survival became no difference among area socioeconomic strata, but low individual socioeconomic females still has significant high death risk.
In the past, study explored invasive cervical cancer survival without taking Pap smear into account, so study couldn’t explore how Pap smear affect invasive cervical cancer survival. This study took Pap smear into account when analysis invasive cervical cancer survival. Study revealed that even under free Pap smear without economic threshold, low individual socioeconomic females still has low Pap smear using, and has high invasive cervical cancer incident and death risk. Although Pap smear has protect effect to invasive cervical cancer patients, the same Pap screen practice still couldn’t achieve equal among invasive cervical cancer survival. If this mechanism couldn’t be unraveled, it could weaken Pap screen in order to early detect and early treat, and weaken free Pap screen in order to reduce socioeconomic health inequality.

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