Cervical cancer screening and acute care visits among Medicaid enrollees with mental and substance use disorders.
OBJECTIVE
This study compared rates of cervical cancer screening and acute care (primary or gynecological) visits among women with and without a diagnosis of psychosis, substance use disorder, bipolar disorder or mania, or depression.


METHODS
Using data about women (N=105,681) enrolled in Maryland's Medicaid program in fiscal year 2005, the authors constructed logistic models with cancer screening and acute care visits as dependent variables and serious mental illness flags as independent variables. Covariates were age, race, geography, Medicaid eligibility category, and sexually transmitted diseases. The logistic model of cervical cancer screening outcomes was repeated with acute care visits as a covariate.


RESULTS
Women with psychosis (N=4,747), bipolar disorder or mania (N=3,319), or depression (N=5,014) were significantly (p<.05) more likely than women in a control group without such disorders (N=85,375) to receive cancer screening (adjusted odds ratio (AOR) range=1.46-1.78) and to have associated acute care visits (AOR range=1.45-2.15). Compared with those in the control group, women with a substance use disorder, with (N=1,104) or without (N=6,122) psychosis, demonstrated reduced odds of cancer screening (AOR=.80) but similar odds of acute care visits (AOR=1.04). Acute care visits were strongly correlated with cancer screens. Genital cancer prevalence did not significantly differ among diagnostic groups.


CONCLUSIONS
In Maryland Medicaid, the odds of cancer screening and related acute care visits were greater for women with major mental disorders compared with women in the control group. For women with substance use disorders, however, screening was reduced and acute care visits were similar compared with women in the control group. Providers should encourage and support their patients with substance use disorders to increase use of preventive care services by primary care physicians and gynecologists.
The Hilltop Institute, University of Maryland, Baltimore County, 1000 Hilltop Circle, Sondheim Bldg., Third Floor, Baltimore, MD 21250, USA. mabrams@hilltop.umbc.edu
Michael T
MT
Abrams
Carol S
CS
Myers
Stephanie M
SM
Feldman
Cynthia
C
Boddie-Willis
Junyong
J
Park
Robert P
RP
McMahon
Deanna L
DL
Kelly
D000328:Adult; D001714:Bipolar Disorder; D016022:Case-Control Studies; D003866:Depressive Disorder; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008396:Maryland; D008403:Mass Screening / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data*; D028642:Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D008875:Middle Aged; D011314:Preventive Health Services / Q000706:statistics & numerical data; D011618:Psychotic Disorders; D012749:Sexually Transmitted Diseases; D019966:Substance-Related Disorders; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*