Disability and Participation in Colorectal Cancer Screening: A Systematic Review and Meta-Analysis

Abstract

Background: The aim of this study is to assess the impact of disability on participation in CRC screening and to determine the overall effect size.

Methods: We conducted a systematic review and meta-analysis to compare CRC screening participation in individuals with and without disabilities. The search encompassed five databases (PubMed, EMBASE, Scopus, Google Scholar, medRxiv). Pooled estimates were calculated for each type of CRC screening and disability categories to synthesize the findings. The participation in CRC screening was derived using a random effects model.

Results: A total of 20 articles were included, most of them from the USA. Based on pooled estimates, individuals with disabilities have lower odds of undergoing CRC screening versus those without disabilities (OR = 0.80, 95%CI 0.73-0.87). Analysis by screening type indicated that individuals with a disability have lower odds of a fecal occult blood test or a fecal immunochemical test (OR: 0.72, 95%CI 0.65-0.81), with no significant difference for a colonoscopy. Individuals with intellectual disabilities had significantly lower rates of CRC screening participation (OR = 0.65, 95%CI 0.53-0.79), especially for FOBT/FIT (OR = 0.58, 95%CI 0.49-0.69).

Conclusions: Disparities exist for CRC screening participation in people with disabilities. Further research and coordinated efforts are essential to develop interventions for improving early cancer diagnosis for this non-negligible patient group.

Keywords: colorectal cancer; disability; screening.

Figure 1

PRISMA flow diagram.

Figure 2

Pooled odds ratio estimates of any CRC screening participation by disability status [23,24,25,26,27,28,29,30,32,33,34,36,37,38,39,40,41]. Blue squares show the odds ratios (ORs) for individual studies, with horizontal lines for 95% confidence intervals. Red diamonds represent the pooled ORs for each screening method subgroup and the green diamond indicates the overall pooled OR for all studies. The green dashed line indicates the overall pooled OR, allowing comparison with subgroup and individual study ORs. The vertical dotted line indicates the null effect threshold.

Figure 3

Pooled odds ratio estimates of FOBT or FIT participation by functional disability status [37,38,41]. Blue squares show the odds ratios (ORs) for individual studies, with horizontal lines for 95% confidence intervals and the green diamond indicates the overall pooled OR for all studies. The green dashed line indicates the overall pooled OR, allowing comparison with individual study ORs. The vertical dotted line indicates the null effect threshold.

Figure 4

Pooled odds ratio estimates of any CRC screening participation by visual impairment status [24,26,33,37,38,41]. Blue squares show the odds ratios (ORs) for individual studies, with horizontal lines for 95% confidence intervals and the green diamond indicates the overall pooled OR for all studies. The green dashed line indicates the overall pooled OR, allowing comparison with individual study ORs. The vertical dotted line indicates the null effect threshold.

Figure 5

(a) Pooled odds ratio estimates of any CRC screening participation by intellectual disability status [26,33,34,37,38,40,41]. (b) Pooled odds ratio estimates of FOBT or FIT participation by intellectual disability status [37,38,40,41]. Blue squares show the odds ratios (ORs) for individual studies, with horizontal lines for 95% confidence intervals and the green diamond indicates the overall pooled OR for all studies. The green dashed line indicates the overall pooled OR, allowing comparison with individual study ORs. The vertical dotted line indicates the null effect threshold.

Figure 5

(a) Pooled odds ratio estimates of any CRC screening participation by intellectual disability status [26,33,34,37,38,40,41]. (b) Pooled odds ratio estimates of FOBT or FIT participation by intellectual disability status [37,38,40,41]. Blue squares show the odds ratios (ORs) for individual studies, with horizontal lines for 95% confidence intervals and the green diamond indicates the overall pooled OR for all studies. The green dashed line indicates the overall pooled OR, allowing comparison with individual study ORs. The vertical dotted line indicates the null effect threshold.

Figure 6

Pooled odds ratio estimates of any CRC screening participation by psychosocial disability status [23,30,37,39,41]. Blue squares show the odds ratios (ORs) for individual studies, with horizontal lines for 95% confidence intervals and the green diamond indicates the overall pooled OR for all studies. The green dashed line indicates the overall pooled OR, allowing comparison with individual study ORs. The vertical dotted line indicates the null effect threshold.