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Preventive Pap Smear Use among Women with Intellectual Disability, Autism, and Down Syndrome: Long-term Analysis and its Following Outpatient Visits

智能障礙、自閉症與唐氏症婦女子宮頸抹片篩檢與婦科門診利用之趨勢分析

摘要


Pap smear has become one of the most widely accepted screening procedures for cervical cancer. However, disabled women are less likely to receive these services. The present paper aims to analyze long-term Pap smear users and their subsequent outpatient care visits among women with intellectual disabilities (ID), autism, and Down syndrome, based on population-based data in Taiwan. A retrospective study was conducted using the National Health Insurance Research Dataset from the Taiwan National Health Insurance program. Those female insurers with ID, autism, and Down syndrome aged 30 years old and older were recruited for the analyses, and the study population comprised 9,077 to 20,296 subjects in the year 1997 to 2011. The results revealed that the over usage rate of Pap smear was 13.9% to 24.66% during the previous 15 years, and the usage trend was increasing gradually. Women in the age groups 40-50 and 50-60 years old were more likely to use the Pap smear test than other age groups. There was a higher usage rate of Pap smear test in women with Down syndrome than women with ID or autism. Women had ever used Pap smear tests were significantly more likely to use further outpatient checks in obstetrics and gynecology departments for ovary, uterus and cervix complications than their counterparts. This study highlights that the future health policy should monitor Pap smear provision and the following medication, to improve the quality of preventive care for women with disabilities.

並列摘要


子宮頸抹片篩檢是我國衛生福利部推動的女性預防保健中重要項目之一。本研究利用國家衛生研究院1997-2011年健保資料庫分析30歲以上智能障礙、自閉症與唐氏症女性接受子宮頸抹片篩檢之利用情形、變化趨勢與婦科門診利用。結果發現,於15年的研究期間有13.9%至24.66%之樣本曾經接受子宮頸抹片篩檢,40~59歲族群接受篩檢的百分比高於其他年齡,唐氏症婦女接受子抹篩檢的情形高於其他兩族群。進一步分析發現,接受子抹之個案至婦產科門診之情形亦高於未接受子抹之個案。全民健保提供之預防保健服務,目的在於早期發現早期治療,以保障國人健康與減少輕症惡化成重症之醫療支出。如何降低智能障礙等國民因為健康識能不足所導致之健康不平等,是有關單位應注意之議題。

參考文獻


Armour, B. S., Thierry, J. M., & Wolf, L. A. (2009). State-level differences in breast and cervical cancer screening by disability status: United States, 2008. Women’s Health Issues, 19, 406-414.
Chen, L. S., Chou, Y. J., Tsay, J. H., Lee, C. H., Chou, P., & Huang, N. (2009).Variation in the cervical cancer screening compliance among women with disability. Journal of Medical Screening, 16, 85-90.
Cobigo, V., Ouellette-Kuntz, H., Balogh, R., Leung, F., Lin, E., & Lunsky, Y. (2013). Are cervical and breast cancer screening programmes equitable? The case of women with intellectual and developmental disabilities. Journal of Intellectual Disability Research, 57, 478-488.
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Drew, J. A., & Short, S. E. (2010).Disability and Pap smear receipt among U.S. Women, 2000 and 2005. Perspectives on Sexual and Reproductive Health, 42, 258-266.

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