Principles for Service Delivery: Best Practices for Cervical Screening for Women with Disabilities

Figures & data

Figure 1 The Missing Billion Health System Framework.

Notes: Reprinted from The Lancet HIV, Volume 9/ Edition 4, Kuper H, Heydt P, Davey C. A focus on disability is necessary to achieve HIV epidemic control, pages e293-e298, copyright 2022, with permission from Elsevier.²⁰

Table 1 Studies Included in the Systematic Review of Screening Uptake by Disability Status

Author, Year	Country	Data Source	Disability Type	Percent of Eligible Women with Disabilities	Uptake Women with Disabilities	Uptake Women Without Disabilities	Adjusted OR
Abrams, 2012^Citation36	USA	Medicaid records	Psychosocial	NR	25%	18%	1.46 (1.36–1.57)
Baruch, 2022^Citation38	Israel	Health records of HMO	Physical	1.7%	57%	63%	0.83 (0.79–0.88)
Brown, 2016^Citation39	Canada	Clinical record from provincial database	Intellectual and developmental	NR	68%	77%	0.61 (0.58–0.65)
Chen, 2023^Citation40	Taiwan	Linked registers	Any	NR	17%	22%	0.74 (0.73–0.76)
Cobigo, 2013^Citation41,a	Canada	Clinical record from provincial database	Intellectual and developmental	NR	34%	67%	0.21 (0.20–0.21)
Eriksson, 2019^Citation42,*	Sweden	Three linked regional health registers	Psychosocial	NR	86%	89%	0.98 (0.97–0.98)
Horner-Johnson, 2015^Citation43,a	USA	Medical Expenditure Panel Survey from the Agency for Healthcare Research and Quality	Functional	NR	Rural: 77%	84%	0.69 (0.59–0.81)
					Urban: 82%	87%	0.78 (0.87–0.96)
Hu, 2023^Citation44	Sweden	Linked registers	Psychosocial	13.3%	68.3%	71.2–71.4%	0.95 (0.95–0.95)
Ko, 2011^Citation45,a	South Korea	Korean National Health and Nutrition Examination Survey	Physical and psychosocial	4.0%	>30 years: 29%	45%	0.71 (0.41–1.22)
					>40 years: 23%	43%	0.52 (0.27–0.98)
Kushalnagar, 2019^Citation46,a	USA	Health Information National Trends Survey	Hearing	NR	78%	85%	0.71 (0.56–0.86)
Murphy, 2021^Citation47,a	USA	MarketScan commercial insurance administrative claims	Psychosocial	16.8%	52%	61%	0.80 (0.80–0.81)
Orji, 2023^Citation48	USA	Behavioral Risk Factor Surveillance System (BRFSS)	Sensory, cognitive or physical	NR	Cognitive: 56%	55%	any disability (AOR=0.95, 95% CI=0.88, 0.97), physical disability (AOR=0.96, 95% CI=0.80, 0.98), and ≥2 disabilities (AOR=0.88, 95% CI=0.78, 0.97)
					Sensory: 50%
					Physical: 48%
Osborn, 2012^Citation49,a	UK	The Health Improvement Network UK primary care database	Intellectual	NR	68%	85%	IRR = 0.54 (0.52–0.56) *
Shin, 2018^Citation50,a	South Korea	Two linked databases (disability, cancer screening)	Physical and psychosocial	4.0%	54%	60%	0.71 (0.71–0.72)
Steele, 2017^Citation51,a	USA	National Health Interview Survey	Any disability	11.9%	72%	82%	0.77 (0.60–0.99)
Weitlauf, 2013^Citation37,a	USA	Electronic record from the VHA National Patient Care Database	Psychosocial	50.7%	n/a		Depression: 1.05 (0.99–1.12)
							PTSD: 1.14 (1.06–1.22)
Woodhead, 2016^Citation52,a	UK	Electronic health record from the South London and Maudsley NHS Trust	Psychosocial	5.2%	80%	78%	0.35 (0.29–0.42)
Xu, 2017^Citation53,a	USA	South Carolina Medicaid Claims	Intellectual	NR	64%	81%	Full adherence: 0.17 (0.16–0.19) Partial adherence: 0.37 (0.34–0.40)
Zanwar, 2022^Citation54	USA	Medical Expenditure Panel Survey	Any disability	15.60%	82%	89%	P<0.001

Note: ^aIncluded in Previous review.⁸

Figure 2 Flowchart showing identification of studies.

Figure 3 Pooled adjusted odds ratio estimates of cervical cancer screening uptake by disability status.

Kuper H, Heydt P and Davey C. A focus on disability is necessary to achieve HIV epidemic control. Lancet HIV. 2022;9(4):e293–e298. doi: 10.1016/S2352-3018(21)00345-3

 PubMed Web of Science ®Google Scholar

Abrams MT, Myers CS, Feldman SM, et al. Cervical cancer screening and acute care visits among Medicaid enrollees with mental and substance use disorders. Psychiatr Serv. 2012;63(8):815–822. doi:10.1176/appi.ps.201100301

 PubMed Web of Science ®Google Scholar

Baruch L, Bilitzky-Kopit A, Rosen K, Adler L. Cervical cancer screening among patients with physical disability. J Womens Health. 2022;31(8):1173–1178. doi:10.1089/jwh.2021.0447

 Web of Science ®Google Scholar

Brown HK, Plourde N, Ouellette-Kuntz H, Vigod S, Cobigo V. Brief report: cervical cancer screening in women with intellectual and developmental disabilities who have had a pregnancy. J Intellect Disabil Res. 2016;60(1):22–27. doi:10.1111/jir.12225

 PubMed Web of Science ®Google Scholar

Chen CY, Kung PT, Chiu LT, Tsai WC. Comparison of cervical cancer screening used between individuals with disabilities and individuals without disabilities. Healthcare. 2023;11:1.

 Web of Science ®Google Scholar

Cobigo V, Ouellette-Kuntz H, Balogh R, Leung F, Lin E, Lunsky Y. Are cervical and breast cancer screening programmes equitable? The case of women with intellectual and developmental disabilities. J Intellect Disabil Res. 2013;57(5):478–488. doi:10.1111/jir.12035

 PubMed Web of Science ®Google Scholar

Eriksson EM, Lau M, Jönsson C, et al. Participation in a Swedish cervical cancer screening program among women with psychiatric diagnoses: a population-based cohort study. BMC Public Health. 2019;19(1):313. doi:10.1186/s12889-019-6626-3

 PubMedGoogle Scholar

Horner-Johnson W, Dobbertin K, Lee JC, Andresen EM; Expert Panel on D, Health D. Disparities in chronic conditions and health status by type of disability. Disabil Health J. 2013;6(4):280–286. doi:10.1016/j.dhjo.2013.04.006

 PubMed Web of Science ®Google Scholar

Hu K, Wang J, Sparén P, et al. Invasive cervical cancer, precancerous lesions, and cervical screening participation among women with mental illness in Sweden: a population-based observational study. Lancet Public Health. 2023;8(4):e266–e275. doi:10.1016/s2468-2667(23)00026-9

 PubMed Web of Science ®Google Scholar

Ko KD, Lee KY, Cho B, et al. Disparities in health-risk behaviors, preventive health care utilizations, and chronic health conditions for people with disabilities: the Korean national health and nutrition examination survey. Arch Phys Med Rehabil. 2011;92(8):1230–1237. doi:10.1016/j.apmr.2011.03.004

 PubMed Web of Science ®Google Scholar

Kushalnagar P, Engelman A, Simons AN. Deaf women’s health: adherence to breast and cervical cancer screening recommendations. Am J Prev Med. 2019;57(3):346–354. doi:10.1016/j.amepre.2019.04.017

 PubMed Web of Science ®Google Scholar

Murphy KA, Stone EM, Presskreischer R, McGinty EE, Daumit GL, Pollack CE. Cancer screening among adults with and without serious mental illness: a mixed methods study. Med Care. 2021;59(4):327–333. doi:10.1097/mlr.0000000000001499

 PubMed Web of Science ®Google Scholar

Orji AF, Gimm G, Desai A, Parekh T. The association of cervical cancer screening with disability type among U.S. Women (Aged 25-64 Years). Am J Prev Med. 2023;66:83–93. doi:10.1016/j.amepre.2023.08.010

 PubMed Web of Science ®Google Scholar

Osborn DP, Horsfall L, Hassiotis A, Petersen I, Walters K, Nazareth I. Access to cancer screening in people with learning disabilities in the UK: cohort study in the health improvement network, a primary care research database. PLoS One. 2012;7(8):e43841. doi:10.1371/journal.pone.0043841

 PubMed Web of Science ®Google Scholar

Shin DW, Lee JW, Jung JH, et al. Disparities in Cervical Cancer Screening Among Women With Disabilities: a National Database Study in South Korea. J Clin Oncol. 2018;36(27):2778–2786. doi:10.1200/jco.2018.77.7912

 PubMed Web of Science ®Google Scholar

Steele CB, Townsend JS, Courtney-Long EA, Young M. Prevalence of cancer screening among adults with disabilities, United States, 2013. Prev Chronic Dis. 2017; 14:E09. doi:10.5888/pcd14.160312

 PubMed Web of Science ®Google Scholar

Weitlauf JC, Jones S, Xu X, et al. Receipt of cervical cancer screening in female veterans: impact of posttraumatic stress disorder and depression. Womens Health Issues. 2013;23(3):e153–9. doi:10.1016/j.whi.2013.03.002

 PubMed Web of Science ®Google Scholar

Woodhead C, Cunningham R, Ashworth M, Barley E, Stewart RJ, Henderson MJ. Cervical and breast cancer screening uptake among women with serious mental illness: a data linkage study. BMC Cancer. 2016;16(1):819. doi:10.1186/s12885-016-2842-8

 PubMedGoogle Scholar

Xu X, McDermott SW, Mann JR, et al. A longitudinal assessment of adherence to breast and cervical cancer screening recommendations among women with and without intellectual disability. Prev Med. 2017;100:167–172. doi:10.1016/j.ypmed.2017.04.034

 PubMed Web of Science ®Google Scholar

Zanwar PP, Davis MM, Horner-Johnson W. Assessing intersectional disparities in cervical cancer screening by disability status, race, and ethnicity. AJPM Focus. 2022;1(2):100019. doi:10.1016/j.focus.2022.100019

 PubMedGoogle Scholar

Andiwijaya FR, Davey C, Bessame K, Ndong A, Kuper H. Disability and participation in breast and cervical cancer screening: a systematic review and meta-analysis. Int J Environ Res Public Health. 2022;19(15):9465. doi:10.3390/ijerph19159465

 PubMed Web of Science ®Google Scholar