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Research article:
Breast and cervical cancer screening utilization, and recording bias, in women with type 2 diabetes (UK)
Reference:
Matthew Carr, Evan Kontopantelis, Tim Doran, Christine Campbell, Lorraine Lipscombe, Emma Crosbie, Anthony Howell, Iain E Buchan, Andrew G Renehan (2015) Breast and cervical cancer screening utilization, and recording bias, in women with type 2 diabetes (UK). Diabetologia, doi:
- Link to article
- Abstract
- Aims/hypothesis: Studies from healthcare databases suggest that patients with type 2 diabetes (T2D) under-utilize cancer screening opportunities, but recording bias may be a problem. We evaluated the relative effect of T2D on screening utilization trends among long-established UK national programmes in breast and cervical cancers; and tested the impact of introducing a primary care financial incentive scheme (QOF) in 2004, known to improve data recording for diabetes-related care. Materials and methods: Using the Clinical Practice Research Datalink, we identified women with prevalent T2DM (N = 174,256), separately by year for 1999 to 2011, and eligible for screening events for breast (aged 50-70 years) and cervical (aged 35-49 and 50-64 years) cancers. We described secular trends and compared these with the non-diabetes population, and accounted for co-morbidities using matched conditional logistic regression models. We performed interrupted time-series (ITS) analyses to assess the impact of the QOF introduction. Results: Compared with the non-diabetes population, relative uptake rates for breast and cervical screening were generally similar in patients with T2D pre-2004, becoming greater for years post-2004. These patterns were unaffected by adjustment for GP practice, and were not accounted for by T2D associated co-morbidities. ITS analysis showed increased activities in all three screening groups for 2007, but these broadly returned to pre-2004 trends by 2011, paralleling similar patterns in recording for other care provision indicators. Conclusions/interpretation: In this population, we found no evidence that women with T2D under-utilize breast and cervical cancer screening opportunities. A financial incentive scheme was associated with intermediate-term improvements in screening utilization, but this is likely to reflect improved recording of care events.
- Author for correspondence
- Andrew Renehan
- Email for correspondence
- arenehan@picr.man.ac.uk
Code list: res22: screen_cervical
91 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 4149.00 | Read | Cervical cytology sample sent to laboratory | test | res22: screen_cervical | |||
| 4JRL.00 | Read | Cervical cytology screening test | test | res22: screen_cervical | |||
| 4K2..00 | Read | Cervical smear result | test | res22: screen_cervical | |||
| 4K21.00 | Read | Cervical smear:inadequate spec | test | res22: screen_cervical | |||
| 4K2..11 | Read | Dyskaryosis on cervical smear | test | res22: screen_cervical | |||
| 4K2..12 | Read | Dysplasia (dysk.)on cerv.smear | test | res22: screen_cervical | |||
| 4K22.00 | Read | Cervical smear: negative | test | res22: screen_cervical | |||
| 4K22.11 | Read | Smear NAD: no endocervic cells | test | res22: screen_cervical | |||
| 4K23.00 | Read | Cerv.smear: mild dyskaryosis | test | res22: screen_cervical | |||
| 4K24.00 | Read | Cerv.smear: severe dyskaryosis | test | res22: screen_cervical | |||
| 4K25.00 | Read | Cerv.smear:severe dysk.?inv.ca | test | res22: screen_cervical | |||
| 4K26.00 | Read | Cervical smear: ? gland neopl. | test | res22: screen_cervical | |||
| 4K27.00 | Read | Cervical smear:atrophic change | test | res22: screen_cervical | |||
| 4K27.11 | Read | Atrophic change on cerv.smear | test | res22: screen_cervical | |||
| 4K28.00 | Read | Cerv.smear: mod.dyskaryosis | test | res22: screen_cervical | |||
| 4K29.00 | Read | Cerv.smear: borderline changes | test | res22: screen_cervical | |||
| 4K2A.00 | Read | Cervical smear endocervical cells present | test | res22: screen_cervical | |||
| 4K2B.00 | Read | Cervical smear endocervical cells absent | test | res22: screen_cervical | |||
| 4K2C.00 | Read | Smear NAD - no endocervical cells | test | res22: screen_cervical | |||
| 4K2D.00 | Read | Cervical smear transformation zone cells present | test | res22: screen_cervical | |||
| 4K2E.00 | Read | Cervical smear transformation zone cells absent | test | res22: screen_cervical | |||
| 4K2F.00 | Read | test | res22: screen_cervical | ||||
| 4K2Z.00 | Read | Cervical smear result NOS | test | res22: screen_cervical | |||
| 4K2Z.11 | Read | Nuclear abnormality on smear | test | res22: screen_cervical | |||
| 4K3..00 | Read | Cervical smear - inflam.change | test | res22: screen_cervical | |||
| 4K31.00 | Read | Cervical smear-no inflammation | test | res22: screen_cervical | |||
| 4K32.00 | Read | Cervical smear-severe inflamm. | test | res22: screen_cervical | |||
| 4K33.00 | Read | Cervical smear - trichomonas | test | res22: screen_cervical | |||
| 4K34.00 | Read | Cervical smear - candida | test | res22: screen_cervical | |||
| 4K35.00 | Read | Cerv.smear - viral infl.unsp. | test | res22: screen_cervical | |||
| 4K35.11 | Read | Viral changes on cerv. smear | test | res22: screen_cervical | |||
| 4K36.00 | Read | Cervical smear - wart virus | test | res22: screen_cervical | |||
| 4K36.12 | Read | HPV changes: cervical smear | test | res22: screen_cervical | |||
| 4K3A.00 | Read | Cervical smear: koilocytosis | test | res22: screen_cervical | |||
| 4K3B.00 | Read | Cervical smear - mild inflammation | test | res22: screen_cervical | |||
| 4K3C.00 | Read | Cervical smear - moderate inflammation | test | res22: screen_cervical | |||
| 4K3Z.00 | Read | Cervical smear - inflam. NOS | test | res22: screen_cervical | |||
| 4K4..00 | Read | Cervical smear - action needed | test | res22: screen_cervical | |||
| 4K48.00 | Read | Cx. smear: colposcopy needed | test | res22: screen_cervical | |||
| 4K49.00 | Read | Cx. smear:cervical biopsy need | test | res22: screen_cervical | |||
| 4K4Z.00 | Read | Cervical smear action NOS | test | res22: screen_cervical | |||
| 4K55.00 | Read | Cervical cytology test | test | res22: screen_cervical | |||
| 4KA..00 | Read | Vaginal vault smear result | test | res22: screen_cervical | |||
| 4KA1.00 | Read | Vaginal vault smear negative | test | res22: screen_cervical | |||
| 4KA4.00 | Read | Vaginal vault smear abnormal | test | res22: screen_cervical | |||
| 685..00 | Read | Cervical neoplasia screening | test | res22: screen_cervical | |||
| 685..11 | Read | Cervical cytology screen | test | res22: screen_cervical | |||
| 685..12 | Read | Cervical smear screen | test | res22: screen_cervical | |||
| 6859.00 | Read | Ca cervix - screen done | test | res22: screen_cervical | |||
| 6859.11 | Read | Cervical cytology examination | test | res22: screen_cervical | |||
| 685A.00 | Read | Ca cervix screen-no result yet | test | res22: screen_cervical | |||
| 685B.00 | Read | Ca cervix screen normal | test | res22: screen_cervical | |||
| 685C.00 | Read | Ca cervix screen abnormal | test | res22: screen_cervical | |||
| 685D.00 | Read | Ca cervix screen + fee claim | test | res22: screen_cervical | |||
| 685E.00 | Read | Cervical smear status unknown | test | res22: screen_cervical | |||
| 685R.00 | Read | Liquid based cervical cytology screening | test | res22: screen_cervical | |||
| 685Z.00 | Read | Ca cervix screen NOS | test | res22: screen_cervical | |||
| 7E2A000 | Read | Exam female genital tract under anaesth & Papanicolau smear | test | res22: screen_cervical | |||
| 7E2A200 | Read | Papanicolau smear NEC | test | res22: screen_cervical | |||
| 7E2A211 | Read | Cervical smear NEC | test | res22: screen_cervical | |||
| 7E2A300 | Read | Vaginal vault smear | test | res22: screen_cervical | |||
| 981..00 | Read | FP74 - cervical cytology claim | test | res22: screen_cervical | |||
| 981..11 | Read | Cervical smear - fee claim | test | res22: screen_cervical | |||
| 9O81.00 | Read | Cervical smear - 1st call | test | res22: screen_cervical | |||
| 9O8A.00 | Read | Abnormal smear - 1st recall | test | res22: screen_cervical | |||
| 9O8R.00 | Read | Smear normal - pt. notified | test | res22: screen_cervical | |||
| 9O8T.00 | Read | Cervical smear slide lost in transit | test | res22: screen_cervical | |||
| 9O8U.00 | Read | Cervical smear slide broken in transit | test | res22: screen_cervical | |||
| 9O8V.00 | Read | Place cervical smear taken | test | res22: screen_cervical | |||
| R150.00 | Read | [D]Nonspecific abnormal Papanicolaou cervical smear | test | res22: screen_cervical | |||
| R150000 | Read | [D]Dyskaryotic cervical smear | test | res22: screen_cervical | |||
| R150100 | Read | [D] Koilocytosis - cervical smear | test | res22: screen_cervical | |||
| R150.11 | Read | [D]Cervical smear - nonspecific abnormality | test | res22: screen_cervical | |||
| R150.12 | Read | [D]Papanicolaou smear - nonspecific abnormality | test | res22: screen_cervical | |||
| R150z00 | Read | [D]Nonspecific abnormal Papanicolaou cervical smear NOS | test | res22: screen_cervical | |||
| R151.00 | Read | [D]Nonspecific abnormal Papanicolaou smear of other origin | test | res22: screen_cervical | |||
| ZV76200 | Read | [V]Screening for malignant neoplasm of cervix | test | res22: screen_cervical | |||
| ZV76211 | Read | [V]Routine Papanicolaou smear | test | res22: screen_cervical | |||
| ZV76212 | Read | [V]Routine cervical smear | test | res22: screen_cervical | |||
| 9O89.00 | OXMIS | SMEAR ABNORMAL - PATIENT TOLD | test | res22: screen_cervical | |||
| 9O89.11 | OXMIS | SMEAR ABNORMAL - PT. NOTIFIED | test | res22: screen_cervical | |||
| L3230T | OXMIS | CERVICAL SMEAR TAKEN | test | res22: screen_cervical | |||
| L9160 | OXMIS | PAP SMEAR EXAMINATION | test | res22: screen_cervical | |||
| L9160NG | OXMIS | PAP SMEAR NEGATIVE | test | res22: screen_cervical | |||
| L9161AC | OXMIS | CERVICAL SMEAR ABNORMAL | test | res22: screen_cervical | |||
| L9162 | OXMIS | CERVICAL SMEAR | test | res22: screen_cervical | |||
| L9162BA | OXMIS | SMEAR INFLAMED | test | res22: screen_cervical | |||
| L9162N | OXMIS | NEGATIVE - CERVICAL SMEAR | test | res22: screen_cervical | |||
| L9162PJ | OXMIS | CARCINOMA IN SITU - CERVICAL SMEAR | test | res22: screen_cervical | |||
| L9162PP | OXMIS | CERVICAL SMEAR CIN I | test | res22: screen_cervical | |||
| L9162PQ | OXMIS | CERVICAL SMEAR CIN II | test | res22: screen_cervical |
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