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Women with disabilities less likely to undergo cervical cancer screening
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Women with physical and mental disabilities appeared significantly less likely to undergo cervical cancer screening, according to a South Korean population-based study.
“Cervical cancer screening enables the detection of precursor lesions and early-stage cancer, contributing to dramatic decreases in incidence and mortality of the disease in developed countries,” Jong Hyock Park, MD, MPH, PhD, of College of Medicine/Graduate School of Health Science Business Convergence at Chungbuk National University in South Korea, and colleagues wrote. “Women with disabilities are diverse, and the ability to access and receive preventive care depends on the specific type and severity of disability. The various barriers associated with different disabilities have important implications for the design of tailored interventions to improve screening participation.”
Cervical cancer screening is provided at no cost in South Korea by the National Cancer Screening Program.
Park and colleagues conducted a population study using data from the Korean National Health Insurance Service, and they determined disability presence, type and severity through the Korean Disability Registration System, which contains data on 15 disability types and six levels of severity.
The number of women invited to undergo cervical cancer screening was 5.6 million in 2006 and 7.8 million in 2015.
After adjusting for age, cervical cancer screening rates among women with disabilities increased from 20.8% in 2006 to 42.1% in 2015. However, among women without disabilities rates increased at a higher rate, from 21.6% to 53.5%. This represented a 21.3 percentage-point increase among women with disabilities compared with a 31.9-percentage point increase among those without disabilities.
From 2006 to 2015, women with grade 1 disabilities had a 12 percentage-points increase (8.5% vs. 20.5%) in screening compared with a 30.9 percentage-point increase (24.7% vs. 55.6%) among women with grade 6 disabilities.
Across the study period, researchers observed the largest increases in screening rates among women with liver disease (9.8% vs. 43.0%; change, +33.2%), visual disabilities (22.2% vs. 50.3%; change, +28.1%), hearing disabilities (21.2% vs. 48.9%; change, +27.7%), physical disabilities (22.9% vs. 51.4%; change: + 27.5%) and facial disfigurements (21.8% vs. 48.4%, change, +26.8%).
Researchers observed the smallest increases among women with intellectual disabilities (10.1% vs. 21.3%; change: +11.2%), disabilities due to mental disorders (13.2% vs. 28.0%; change, +14.8%), and disabilities due to brain injuries (13.3% vs. 30.6%; change: +17.3%).
Women with disabilities appeared 29% less likely to undergo cervical cancer screening than women with no disabilities after adjustment (OR = 0.71; 95%, 0.71-0.72).
In a subgroup analysis, compared with woman without disabilities, researchers also found screening rates appeared lower among women with:
- severe disabilities (OR = 0.42; 95% CI, 0.42-0.42);
- autism (OR = 0.06; 95% CI 0.03-0.11);
- intellectual disability (OR = 0.25; 95% CI, 0.25- 0.26);
- brain injury (OR = 0.311; 95% CI, 0.31- 0.32);
- ostomy (OR = 0.36; 95% CI,0.33-0.38); or
- mental disorder (OR = 0.43; 95% CI, 0.42-0.44).
“Women with disabilities may not receive cervical cancer screening because of structural barriers (eg, facilities or equipment that are not easily accessible, the cost of screening tests, or the availability of transportation), provider limitations (eg, poor knowledge and negative attitudes, lack of time, and failure to prioritize among multiple demands), and patient factors (eg, lack of knowledge, perceived relevance of screening, and lack of usual source of care),” the researchers wrote. “We also found that more severe disabilities were associated with lower screening rates, suggesting that people with disabilities will not fully benefit from free screening programs without an environment that addresses the physical, social and attitudinal barriers to participation.”
The limitations of the study included the inability to adjust for screening eligibility, opportunistic screening and clinicodemographic variable that may influence screening participation, as well as restrictions in considering individuals with multiple disabilities.
“Our findings must be interpreted within the context of the current Korean health care system,” the researchers wrote. “However, our findings provide important insight for other countries looking to develop universal health coverage and free preventive care, such as the United States.” – by Cassie Homer
Disclosures: The authors report no relevant financial disclosures.
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