Cervical Cancer and Sexually Transmitted Infections Screening Among Individuals with a Substance Use Disorder: A Retrospective Cohort Study

Abstract

Substance use disorders (SUDs) have been associated with barriers to preventive medicine screening, but little is known about the association of SUDs and cervical cancer and sexually transmitted infections (STIs) screening rates. This retrospective cohort study used de-identified medical records to select women aged 31–59 as of January 1, 2019. Logistic regression models were computed to estimate the association between any SUDs, including alcohol, compared to no SUD diagnoses, and odds of cervical cancer and STIs screening during the observation period (2019–2024) before and after controlling for covariates. The final cohort included 315,748 people with an average age of 39.4 (±11.6) years old, of whom 22,343 had SUDs. Eighty-two percent were White, and 12.6% were Black individuals. During the 6-year follow-up period, 41% of the cohort received a cervical cancer screening test. After controlling for covariates, individuals with SUDs were less likely to receive cervical cancer screening compared to those without SUDs (odds ratio [OR] = 0.95; 95% confidence interval [CI]: 0.92–0.98). Opioid and sedative use disorders were significantly associated with lower odds of cervical cancer screening (OR = 0.86; 95% CI: 0.81–0.92 and OR = 0.85; 95% CI: 0.72–0.99, respectively). Individuals with SUDs were more likely to receive STI screen compared with those without SUDs (OR = 1.08; 95% CI: 1.05–1.12). An SUD diagnosis is a modest barrier to cervical cancer screening and is associated with more STI screening. Health care professionals must work with multidisciplinary teams to identify and address these barriers.