Cervical Cancer Screening Overuse Among Women With and Without Disability in the U.S. From 2007 to 2016

Abstract

Introduction: Persons with disability, a recognized health disparity population with complex care needs, may be at risk for cervical cancer screening overuse. However, limited studies have examined cervical cancer screening overuse among women with and without disability using large nationally representative survey data. Among women with and without disability, the authors aimed to provide national estimates of cervical cancer screening overuse and the proportion of cervical cancer screening overuse among younger, middle-age, and older women.

Methods: The authors first utilized the U.S. Preventive Services Task Force guidelines to conceptualize and define cervical cancer screening overuse for women with and without disability on the basis of age-based recommendations of Papanicolaou testing frequencies. The authors used the definition of disability to include limitations in mobility or walking, hearing, vision, or cognition, activities of daily living, or instrumental activities of daily living as well as limitations in school, work, or housework. The authors then used the Medical Expenditure Panel Survey data pooled from 2007 to 2016 to estimate the survey-weighted proportion of cervical cancer screening overuse among younger women (aged 17-20.9 years and 21-29.9 years), middle-age women (aged 30-64.9 years), and older women (aged ≥65 years).

Results: The analytic sample comprised 101,083 women aged ≥17 years with and without disability or a survey-weighted population of 94.8 million, of whom 52.5% had no disability and 12.97% had any disability. There was a large difference in cervical cancer screening overuse between women with and without disability, with women without disability having much higher overuse rate. The survey-weighted proportion of cervical cancer screening overuse among middle-age women aged 30-64.9 years without disability and with disability was highest (52.5% vs 12.97%, p<0.0001), followed by that among older women without and with disability (8.53% each, p<0.0001).

Conclusions: Cervical cancer screening overuse is potentially occurring in women with and without disability, calling for a need to design multilevel interventions and economic incentives to deimplement low-value cervical cancer screening in healthcare delivery settings.

Keywords: Medical Expenditure Panel Survey; Overuse; Pap testing; cervical cancer screening; disability; women.

Graphical abstract

Figure 1

Flow diagram of analytic sample construction. *A person is considered in scope if he or she is a member of a MEPS household and is a member of the U.S. civilian, noninstitutionalized population and not out of the country on military duty. MEPS, Medical Expenditure Panel Survey.