The Cancer Screening Disparity among Women With Schizophrenia by Co-occurring Chronic Physical Illness Status: A...

To investigate the association between co-occurring chronic physical illnesses (CPIs) and breast and cervical cancer screening rates among women with schizophrenia in Taiwan.

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.

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.

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.

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.