Women with cerebral palsy receive substantially less gynecologic preventive care

BACKGROUND: Adult women are at risk for gynecologic health problems, most of which have established screening guidelines. However, it is unclear whether adult women with cerebral palsy receive this preventive care. OBJECTIVE: The present study aims to identify any gaps in preventive care use among women with cerebral palsy using a large national dataset. STUDY DESIGN: PearlDiver, a national insurance database with patient information from 2010 to Q1 2022, was used to study adult women with cerebral palsy. Women with cerebral palsy were identified using International Classification of Diseases diagnostic codes. The cohort with cerebral palsy was matched 1:4 by age and sex to a cohort without cerebral palsy. Women who underwent routine gynecologic examinations, Pap testing, and mammography were identified. The incidence of each was determined in 5-year intervals from 20 to 69 years of age. Using chi-square tests, the overall difference in the incidence of each preventive care was determined. Multivariable logistic regressions were used to determine if cerebral palsy was an independent predictor of whether a patient used each modality. Multivariable analysis was controlled for age, Elixhauser Comorbidity Index, region of the United States, and insurance plan. RESULTS: After matching, there were 138,277 women with cerebral palsy matched to 553,102 women in the cohort without cerebral palsy. There was a substantially lower incidence of preventive care for the cohort with cerebral palsy for all preventive screenings. Across all years, an average of 31.8% of women in the cohort with cerebral palsy attended at least 1 routine gynecologic examination every 5 years, compared with 79.8% of women in the cohort without cerebral palsy. For Pap tests, across all years, 23.4% of women in the cohort with cerebral palsy had at least 1 Pap test every 5 years, compared with 54.1% of women in the cohort without cerebral palsy. For mammograms, among those aged 40 and older, on average, 44.9% had at least 1 mammogram every 5 years compared with 72.3% of the cohort without cerebral palsy (P<.001 for each). On multivariable analysis, women with cerebral palsy had substantially decreased odds of undergoing Pap tests (odds ratio, 0.26 [P<.001]), mammograms (odds ratio, 0.39 [P<.001]), and gynecologic examinations (odds ratio, 0.15 [P<.001]). CONCLUSION: Women with cerebral palsy receive substantially less preventive care throughout their lives when compared with women without cerebral palsy. This reduction in preventive care can have a detrimental impact on health and longevity. More studies are needed to determine barriers to care for women with cerebral palsy, with the intention of eliminating this disparity.