Schizophrenia Bulletin

Cervical Cancer Screening Among Female Medicaid Beneficiaries With and Without Schizophrenia

Abstract Background and Hypothesis In the United States, women with schizophrenia face challenges in receiving gynecologic care, but little is known about how cervical cancer screening rates vary across time or states in a publicly insured population. We hypothesized that women Medicaid beneficiaries with schizophrenia would be less likely to receive cervical cancer screening across the United States compared with a control population, and that women with schizophrenia and other markers of vulnerability would be least likely to receive screening. Study Design This retrospective cohort study used US Medicaid administrative data from across 44 states between 2002 and 2012 and examined differences in cervical cancer screening test rates among 283 950 female Medicaid beneficiaries with schizophrenia and a frequency-matched control group without serious mental illness, matched on age and race/ethnicity. Among women with schizophrenia, multivariable logistic regression estimated the odds of receiving cervical cancer screening using individual sociodemographics, comorbid conditions, and health care service utilization. Study Results Compared to the control group, women with schizophrenia were less likely to receive cervical cancer screening (OR = 0.76; 95% CI 0.75–0.77). Among women with schizophrenia, nonwhite populations, younger women, urban dwellers, those with substance use disorders, anxiety, and depression and those connected to primary care were more likely to complete screening. Conclusions Cervical cancer screening rates among US women Medicaid beneficiaries with schizophrenia were suboptimal. To address cervical cancer care disparities for this population, interventions are needed to prioritize women with schizophrenia who are less engaged with the health care system or who reside in rural areas.

A Systematic Review of Women’s Cancer Screening and Mortality in Women with Severe Mental Illness

Abstract Background and Hypothesis Breast and cervical cancer remain a significant cause of morbidity and mortality for women worldwide. To combat these high mortality rates, numerous countries have implemented national screening programs. While the relationship between mental illness and screening participation has been examined in past systematic reviews, this is the first systematic review specifically on women with severe mental illness (SMI), referring to women experiencing bipolar affective disorder (BPAD), schizophrenia (SCZ), or associated psychotic disorders. We hypothesized that in comparison to the general population, women with SMI would have lower screening rates and higher mortality relating to breast and cervical cancer. Study Design This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendations. Relevant articles were identified by searching electronic databases including PsycINFO, Ovid MEDLINE, and Embase. A quality assessment was undertaken using the Newcastle–Ottawa Scale. Study Results Thirty-five articles were identified. Twenty-one articles demonstrated lower screening rates in women with SMI for breast or cervical cancer, with adjusted odds ratios (AORs) between 0.33 and 0.81; AORs were lower among women with SCZ and related psychotic disorders than women with BPAD. Eleven articles examined cancer-related mortality and determined women with SMI had higher risks of breast cancer, with conflicting findings for cervical cancer-specific mortality. Conclusions This review found reduced screening rates and higher mortality in women with SMI, suggesting a future focus on understanding the specific barriers and developing targeted screening programs for women with SMI.

The Cancer Screening Disparity among Women With Schizophrenia by Co-occurring Chronic Physical Illness Status: A Nationwide Cohort Study in Taiwan

Abstract Background To investigate the association between co-occurring chronic physical illnesses (CPIs) and breast and cervical cancer screening rates among women with schizophrenia in Taiwan. Study Methods This retrospective cohort study analyzed Taiwan National Health Insurance claims data from 2017 to 2019. The sample included all women with schizophrenia who were eligible for guideline-recommended breast and cervical cancer screenings. Multivariable logistic regression models examined the association between 3 major CPIs (hypertension, type 2 diabetes mellitus, and chronic kidney disease [CKD]) and receipt of cancer screening. We also assessed the relationship between the total number of CPIs (0, 1, 2, or 3) and screening uptake. Average differential effects were estimated with delta-method standard errors, adjusting for relevant sociodemographic and clinical covariates. Study Results Among 22 876 eligible women for breast cancer screening and 38 673 for cervical cancer screening, multivariable analyses showed that hypertension, diabetes, and CKD were each associated with increased probability of receiving mammography (4, 6, and 5 percentage points, respectively; all P < .001), and Pap tests (4, 3, and 4 percentage points, respectively; all P < .001). A greater number of CPIs was also associated with statistically significantly higher rates of both cancer screenings. Conclusions Women with schizophrenia and co-occurring CPIs in Taiwan had higher rates of breast and cervical cancer screenings compared to women with schizophrenia only. Interventions to improve screening uptake may need to prioritize women who are less engaged with the physical healthcare system. Highlights Hypertension, diabetes, and chronic kidney disease were each associated with higher rates of breast and cervical cancer screenings among women with schizophrenia in Taiwan. A greater number of co-occurring chronic physical illnesses was also associated with higher rates of both cancer screenings among women with schizophrenia. Interventions to improve cancer screening uptake in this population may need to focus on women less engaged with physical healthcare services.