Comparison of colorectal cancer screening between people with and without disability: a nationwide matched cohort study

Abstract

Background The World Health Organization has recognized that people with disability are among the most marginalized in the world. This study’s objective was to investigate the differences in the probability of colorectal cancer (CRC) screening with faecal immunochemical testing (FIT) between people with disability and without disability in Taiwan. Methods The study participants included people with and without disability from the Disability Registration Database (2012) and the National Health Insurance Research Database (2009–2012). The study included 50- to 69-year-olds with and without disability who were screened from 2011 to 2012 and were alive in 2012. There were 16 categories of disability. After propensity score matching (PSM) between the two groups, conditional logistic regression analysis with control variables was used to investigate the odds ratio (OR) that people with or without disability would undergo CRC screening. Results The percentage of people with disability receiving CRC screening was 21.84%, and the highest rate of those receiving CRC screening (38.72%) was found in people with intractable epilepsy, whose OR was 1.47 times that of people with moving functional limitation (95% confidence interval (CI) = 1.17–1.85). The results showed that the probability of CRC screening in people with disability was lower than that in people without disability (OR = 0.88, 95%CI = 0.87–0.89). The probability of receiving CRC screening differed between people with different categories of disability. Conclusions Although the probability of CRC screening in the four categories of disability was higher than that in the general population, overall, people with disability were less likely than people without disability to undergo CRC screening. Health inequalities still exist under National Health Insurance in Taiwan.

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

“…Qualitative data shows that women with disabilities report multiple barriers to accessing breast and cervical cancer screening, including physical barriers, cost, a lack of knowledge, fear, and attitudes of healthcare workers [ 46 , 47 , 48 ]. Studies have also shown that colorectal cancer screening is less frequent among people with disabilities compared to those without [ 49 , 50 ]. More broadly, it is well established that people with disabilities face greater challenges in accessing health care services [ 51 ].…”

Unfavorable cancer mortality‐to‐incidence ratios in patients with schizophrenia: A nationwide cohort study in Taiwan, 2000–2019

“…Taiwan's nationwide colorectal cancer screening program implemented in 2004 has been effective in reducing colorectal cancer mortality in this country 46 . Low participation in colorectal screening was observed in patients with intellectual and developmental disability, dementia, or autism in Taiwan 47 . The relatively low incidence rate of colorectal cancer in patients with schizophrenia in the present study may be associated with a low rate of participation in screening programs.…”

“…46 Low participation in colorectal screening was observed in patients with intellectual and developmental disability, dementia, or autism in Taiwan. 47 The relatively low incidence rate of colorectal cancer in patients with schizophrenia in the present study may be associated with a low rate of participation in screening programs. Delayed diagnosis may also contribute to the observed higher mortality rate and relative MIR for colorectal cancer.…”

Do people with disabilities experience disparities in cancer care? A systematic review

“…A recent meta-analysis from the USA showed that women with disabilities have 0.78 (95% CI: 0.72–0.84) lower odds of attending breast cancer screening and have 0.63 (95% CI: 0.45–0.88) lower odds of attending cervical cancer screening, compared to women without disabilities. A recent study from Taiwan reported that the probability of receiving colorectal cancer screening in people in the four categories of disability (intellectual and developmental disability, dementia, multiple disabilities, and moving functional limitation; OR = 0.53, 0.55, 0.62 and 0.81, respectively) was significantly lower than that in the general population [ 24 , 26 ]. Two recent scoping reviews found that patients with intellectual disabilities may be at risk of experiencing inequities at various points during cancer clinical pathways, which as a consequence could have an impact on their overall and cancer-specific mortality and quality of life; it is thus of the outmost importance to identify and address these disparities [ 25 , 27 ].…”