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. 2020 Sep;9(18):6888-6895.
doi: 10.1002/cam4.3333. Epub 2020 Jul 25.

Disparities in cancer-related healthcare among people with intellectual disabilities: A population-based cohort study with health insurance claims data

Maarten Cuypers  1 , Hilde Tobi  2 , Cornelis A A Huijsmans  3 , Lieke van Gerwen  3 , Michiel Ten Hove  3 , Chris van Weel  1   4 , Lambertus A L M Kiemeney  5 , Jenneken Naaldenberg  1 , Geraline L Leusink  1
Affiliations

Disparities in cancer-related healthcare among people with intellectual disabilities: A population-based cohort study with health insurance claims data

Maarten Cuypers et al. Cancer Med. 2020 Sep.

Abstract

Background: Concerns have been raised about the accessibility and quality of cancer-related care for people with intellectual disabilities (ID). However, there is limited insight into cancer incidence and the utilization of cancer care at the ID population level to inform targeted cancer control strategies. Therefore, we aimed to examine differences in the utilization of cancer-related care between people with and without ID, identified through diagnostic codes on health insurance claims.

Methods: In a population-based cohort study, Dutch individuals of all ages who received residential care through the Chronic Care Act due to an ID (n = 65 183) and an age and sex-matched sample of persons without ID (1:2 ratio), who were cancer-free at enrollment in 2013 were followed through 2015. Incidence rates (IRs) of newly started cancer care and IR ratios (IRRs) with 95% CIs were used to compare groups. Separate analyses were performed per cancer type.

Results: Individuals with ID received less cancer-related care than individuals without (IRR = 0.64, 95% CI 0.62-0.66). Differences increased with age and were larger for females than for males. Utilization of care for cancers within the national screening program (female breast, cervical, and colon cancer) was lower for people with ID compared to people without ID.

Conclusion: Cancer may be underdiagnosed and/or undertreated in people with ID, or cancer is truly less prevalent in this population. In particular, the differences detected between males and females with ID, and the potential underutilization of national screening programs, require urgent follow-up investigations.

Keywords: early detection of cancer; healthcare disparities; hospital; intellectual disability; neoplasms; oncology service.

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Conflict of interest statement

Authors declare to have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
ID and general population cohort selection
FIGURE 2
FIGURE 2
Incidence rates (IRs) and incident rate ratios (IRRs) per cancer type for ID and general population cohort, sorted by IRR
See this image and copyright information in PMC

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