Screening for cervical cancer: What are the determinants among adults with disabilities living in institutions? Findings from a National Survey in France.
OBJECTIVE
To explore the rate and determinants of the likelihood of cervical cancer screening participation among disabled women living in institutions in France.


METHODS
The data source was the French national Health and Disability Survey-Institutions Section, 2009. Disability severity was assessed by scoring mobility and cognitive limitations. Chi-square tests revealed the significant factors associated with the screening rates; these factors were used in a multivariate logistic regression of Pap-test use within the 3 years prior to the interview (n=1052, women aged 20-65 years living in institutions for disabled adults).


RESULTS
The cervical cancer screening rate was particularly low in this population. After adjusting for all other covariates, women with more severe degrees of mobility or cognitive limitations had a lower likelihood of receiving a Pap test. Our findings also showed that being socially isolated, illiterate or underweight significantly decreased screening participation.


CONCLUSIONS
Even in institutions, disability severity remains a barrier to cancer screening. Given the increasing prevalence of disabling conditions and cancers, and the lack of previous studies on this specific topic, our findings are highly important from a policy point of view. These findings should alert health authorities to increase their efforts to provide medical care for institutionalized people with disabilities.
Institut National de la Santé et de la Recherche Médicale, Paris, France. Electronic address: clemence.bussiere@u-psud.fr.
Clémence
C
Bussière
Centre National de la Recherche Scientifique, Paris, France.
Marc
M
Le Vaillant
Institut National de la Santé et de la Recherche Médicale, Paris, France.
Nathalie
N
Pelletier-Fleury
D000328:Adult; D000368:Aged; D060825:Cognitive Dysfunction; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D008875:Middle Aged; D051346:Mobility Limitation; D065006:Papanicolaou Test; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*
Cognitive limitations; Disability; Health services research; Institution; Mobility limitations; Pap testing