Women with cerebral palsy receive significantly less gynecologic preventative care.

Abstract

Adult women are at risk for gynecologic health problems, most of which have established screening guidelines. However, it is unclear if adults with cerebral palsy (CP) are receiving this preventative care. The present study aims to identify any gaps in preventative care utilization amongst women with CP using a large national dataset. Pearldiver, a national insurance database with patient information from 2010 to Q1 2022, was utilized to study adult women with CP. Patients with CP were identified using International Classification of Diseases (ICD) diagnostic codes. The cohort was matched 1:4 by age and sex to a cohort without CP. Patients who underwent routine gynecologic exams, Pap tests, and mammograms were identified. The incidence of each was determined in five-year intervals, starting from 20 years of age to 69 years of age. Using chi-square tests, the overall difference in incidence of each preventative care was determined. Multivariable logistic regressions to determine if CP was an independent predictor whether a patient utilized each modality. Multivariable analysis controlled for age, Elixhauser Comorbidity Index (ECI), region of the United States, insurance plan. After matching, there were 138,277 patients with CP matched to 553,102 patients in the non-CP cohort. There was a significantly lower incidence of preventative care for the CP cohort for all preventative screenings. Across all years, on average, 31.8% of the CP cohort attended at least one routine gynecologic exam every five years compared to 79.8% in the non-CP cohort. For pap tests, across all years, 23.4% of the CP cohort had at least one pap test every five years compared to 54.1% of the non-CP cohort. For mammograms, amongst those 40 and older, on average, 44.9% had at least one mammogram every five years versus 72.3% of the non-CP cohort [p < 0.001 for each]. On multivariable analysis, patients with CP had a significantly decreased odds of undergoing pap tests (OR: 0.26, p < 0.001), mammograms (OR: 0.39, p < 0.001), and gynecologic exams (OR: 0.15, p < 0.001. Women with CP are receiving significantly less preventative care throughout their lives when compared to women without CP. This reduction in preventative care can have a detrimental impact on health and longevity. More studies are needed to determine barriers to care for women with CP, with the intention of eliminating this disparity.