Disability and receipt of the Papanicolaou test for cervical cancer screening: A systematic review and meta-analysis
To synthesize literature comparing Papanicolaou (Pap) test receipt between women with and without disabilities. We searched the following databases from inception to March 1, 2024: OVID Medline (1946-), EBSCO CINAHL Plus (1981-), OVID EMBASE (1974-), and OVID APA PsycINFO (1806-). Eligible studies were peer-reviewed and compared receipt of Pap tests in women with physical, hearing, vision, or intellectual/developmental disability versus those without disabilities. We extracted data using a standardized form; study quality was appraised using the Newcastle-Ottawa Scale; and results were synthesized using random-effects meta-analyses, where possible. Findings that could not be meta-analyzed were summarized following Synthesis Without Meta-analysis guidelines. Grading of Recommendations, Assessment, Development and Evaluation was used to assess the strength of evidence. Of 1946 unique studies screened, 43 were included in the review, and 21 were meta-analyzed. Studies were primarily cross-sectional (65.1 %), used survey data (76.7 %), and were conducted in the United States (60.5 %). Quality was rated high (30.2 %), medium (55.8 %), and low (14.0 %). Women with disabilities had a lower likelihood of receiving a Pap test (adjusted pooled OR 0.78, 95 % CI: 0.66-0.91). Disparities were more pronounced among those with physical (adjusted pooled OR 0.74, 95 % CI: 0.68-0.80) and intellectual/developmental disabilities (adjusted ORs ranging from 0.21 to 0.37). The overall strength of evidence was low. Women with disabilities could benefit from efforts to improve cervical cancer screening receipt. Future studies should continue to explore this association, including using population-based data that may better capture the needs of this group.