The double barrier: coronavirus disease 2019 and cervical cancer screening disparities among women with disabilities in South Korea: a nationwide cohort study

The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems, potentially exacerbating pre-existing health disparities. Women with disabilities face structural barriers to healthcare that may be intensified during public health crises. This study aimed to evaluate pandemic-period changes in cervical cancer screening inequities among women with disabilities in South Korea. We analyzed Korean National Health Insurance Service Database data on cervical cancer screening participation among women aged ≥ 20 years, totaling more than 21 million person-years from 2017 to 2020. Multivariable logistic regression compared 2020 screening participation with the 2017–2019 average, adjusting for age, income, and region. Subgroup analyses were stratified by disability status, severity, and disability type. Overall screening participation declined in 2020 (OR = 0.828; 95% CI = 0.827–0.830). The reduction was greater among women with disabilities (OR, 0.758; 95% CI, 0.751–0.765) than among women without disabilities (OR, 0.832; 95% CI, 0.830–0.833), and a post hoc heterogeneity analysis comparing adjusted subgroup estimates supported this difference (ratio of adjusted ORs, 0.911; 95% CI, 0.903–0.920; p < 0.001). Reductions were sharpest for impairments affecting communication: facial (OR = 0.692), speech (OR = 0.713), and hearing (OR = 0.728). Conversely, participation increased among women aged 20–29 (OR = 1.142) but dropped sharply for those aged ≥ 40 (e.g., 40–49: OR = 0.744). During the first year of the COVID-19 pandemic, cervical cancer screening participation declined more among women with disabilities than among those without disabilities, particularly among women with communication-related impairments. These findings suggest that pandemic-period disruptions may have widened pre-existing screening disparities despite universal screening coverage. Equity-focused strategies, such as accessible screening environments and human papillomavirus self-sampling, may help improve resilience and equity in preventive care during public health emergencies.