Variation in the cervical cancer screening compliance among women with disability.
OBJECTIVE
To investigate the relationship between the level of disability and regular Pap smear testing among women in Taiwan and explore how this relationship may vary with the various levels of physician availability.


METHODS
This population-based cohort study followed a total of 5,469,581 women from Taiwan, who were 30 years old or older in 2001 and covered the period January 2001 to December 2003. Of the total study population, 184,701 individuals were women with disability. Gynecologist-obstetrician/general practitioner to female population ratio was used as an indicator of physician availability. Multiple logistical regression models were used.


RESULTS
After adjusting for age, socioeconomic status, racial group, residence area and physician availability, women with severe disability (OR = 0.38; 95% CI: 0.38, 0.39) were the least likely to undergo Pap smear testing. Women with moderate disability (OR = 0.59; 95% CI: 0.58, 0.60) and mild disability (OR = 0.88; 95% CI: 0.86, 0.89) were also significantly less likely to undergo a routine test than women without disability. Women residing in the areas with the greatest physician availability (OR = 0.93; 95% CI: 0.93, 0.94) were significantly less likely to undergo a Pap test than those in the areas with the lowest level of resource availability. The disparity in routine screening between women with and without disability remained across the different levels of physician availability.


CONCLUSIONS
In Taiwan, women with disability were found to be at higher risk of lower compliance than women without disability. The gap between women with and without disability persisted across different levels of physician availability.
Chen
Long-Sheng
LS
Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
Chou
Yiing-Jenq
YJ
Tsay
Jen-Huoy
JH
Lee
Cheng-Hua
CH
Chou
Pesus
P
Huang
Nicole
N
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D006233:Persons with Disabilities; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D065006:Papanicolaou Test; D012044:Regression Analysis; D012923:Social Class; D013624:Taiwan; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000706:statistics & numerical data