Cervical Cancer Screening Among Patients with Physical Disability

Abstract

Background: Pap smear has a central role in cervical cancer screening. Previous studies have found that female patients with disabilities are less likely to receive a Pap smear as recommended by guidelines. The aim of our study was to examine the association between physical disability and Pap smear receipt in Israel. Methods: This cross-sectional study was conducted using the electronic medical records of the second largest health care maintenance organization in Israel. All female patients during 2012–2017 aged 25–65 were identified. The exposure variable was physical disability, and the outcome variable was Pap smear receipt. We used logistic regression to control for covariates. Results: A total of 391,259 patients were eligible for this study, 6,720 (1.7%) with physical disability. 56.7% of patients with disabilities had received Pap smear compared to 63.3% of patients without disabilities, odds ratio (OR) 0.76, 95% confidence interval [CI] 0.72–0.80. When adjusting to sociodemographic and clinical covariates, patients with disabilities were less likely to receive Pap smear, adjusted OR 0.83, 95% CI 0.79–0.88. For all patients, older age, lower socioeconomic status, religious minorities, cardiovascular disease, type-2 diabetes mellitus, hypertension, smoking, and obesity were associated with lower odds of receipt of Pap smear. A history of nongynecologic oncologic disease was associated with increased odds of Pap smear receipt. Conclusion: Our study highlights the disparities between patients with and without physical disability with regard to screening for cervical cancer by receipt of Pap smear. Creating an appropriate practice with adequate access to patients with disability should be a focus for health care providers and policy makers.

Examining Disparities in Cervical Cancer Screening with Pap Test by Types of Disability

“…Some potential reasons for the lower rates of cervical cancer screening among women with an independent living disability, ambulatory disability and multiple disabilities may be physical barriers including inability to access exam tables, 31 environmental barriers including lack of transportation or caregivers, 32 individual factors including older age, lack of health insurance, severe depression and other mental health conditions including anxiety; interpersonal factors including poor access to physician or poor communication with healthcare providers and spousal support. 33,4 We found evidence that receipt of cervical cancer screening with Pap test differed by disability type. Speci cally, the study found that, compared to women with no disabilities, women with multiple and ambulatory disabilities were less likely to receive cervical cancer screening with Pap test after controlling for risk factors associated with cervical cancer screening.…”

Health care utilization in young adults with childhood physical disabilities: a nationally representative prospective cohort study

“…Although the number of routine physician visits did not differ by disability status, frequency of these visitsmay not reflect adequacy of preventive care, as prior studies found reduced rates of screening among people with disabilities [33][34][35], sometimes well below those recommended by the US Preventive Services Task Force [10]. Lower preventive care among those with a physical disability may be due to personal factors (anxiety), social factors (poor communication with providers, feeling of inadequate support), provider factors (prioritizing acute problems over chronic comorbid conditions), or environmental factors (inaccessible exam tables and other physical access barriers) [36][37][38].…”

Turning the tide—Recommendations to increase cervical cancer screening among women who are underscreened

“…Physical disability can make it more difficult to access or attend screening. Barriers can include a lack of wheelchair access, problems getting onto the examination couch for the test, and previous misunderstandings, dismissal, and negative experiences of cervical cancer screening 66,67 Not understanding current cervical cancer screening guidelines 68 …”