Elsevier

Women's Health Issues

Volume 24, Issue 1, January–February 2014, Pages e147-e153
Women's Health Issues

Original article
Breast and Cervical Cancer Screening Disparities Associated with Disability Severity

https://doi.org/10.1016/j.whi.2013.10.009Get rights and content

Abstract

Background

Prior research has noted disparities between women with and without disabilities in receipt of timely screening for breast and cervical cancer. Some studies suggest greater disparities for women with more severe disabilities, but the research to date has yielded inconsistent findings. Our purpose was to further examine differences in receipt of breast and cervical cancer screening in relation to severity of disability.

Methods

We analyzed Medical Expenditure Panel Survey annual data files from 2002 to 2008. Logistic regression analyses examined whether Pap smears and mammograms had been received within the recommended timeframe according to U.S. Preventive Services Task Force Guidelines. We compared four groups of women aged 18 to 64 years, categorized by presence and complexity of disability: 1) No limitations, 2) basic action difficulties only, 3) complex activity limitations only, and 4) both basic and complex activity limitations.

Findings

Women both with and without disabilities fell short of Healthy People 2020 goals for breast and cervical cancer screening. Overall, women with disabilities were less likely to be up to date with both mammograms and Pap tests. The magnitude of disparities was greater for women with complex limitations. Disparities in Pap testing, but not mammography, remained significant when controlling for demographic, geographic, and socioeconomic factors.

Conclusions

Women with more complex or severe disability were less likely to be up to date with breast and cervical cancer screenings. Targeted efforts are needed to reduce barriers to breast and cervical cancer screening for women with significant disabilities, especially those who also experience other socioecological disadvantages.

Section snippets

Data Source

We analyzed annual data files from the household component of the Medical Expenditure Panel Survey (MEPS) pooled across 2002 through 2008. The MEPS is conducted by the Agency for Healthcare Research and Quality to obtain nationally representative data on health care use and expenditures. The MEPS sample is based on in-person interviews with households selected from households participating in the previous year's National Health Interview Survey. The survey uses an overlapping panel design, with

Results

Most of our Pap analytic sample reported no limitations (Table 1). Similar proportions reported either basic only or basic and complex limitations, whereas very few reported complex limitations only. This distribution was similar in our mammography analytic sample (no limitations, 77.3%; basic, 11.4%; complex, 1.8%; both, 9.5%). Generally, as age increased so did disability severity. Roughly 14% of women age 18 to 64 years had gone longer than 3 years without a Pap test and one quarter of those

Discussion

Overall, women both with and without disabilities fell short of Healthy People 2020 goals for breast and cervical cancer screening (U.S. Department of Health and Human Services, 2013). However, women with disabilities were less likely to be up to date with mammograms and Pap tests compared with women with no disabilities. This finding supported our first hypothesis and is consistent with several previous studies that have found similar disparities (Armour et al., 2009, Courtney-Long et al., 2011

Limitations

Although the MEPS is a rich data source for analyses of health care use at a population level, there are some limitations. Specific to this study, data on receipt of breast and cervical cancer screening are based on respondent report rather than medical records. As noted, these reports may be susceptible to bias such that some demographic groups overestimate their receipt of screening relative to other groups (Rauscher et al., 2008). We also note that recommendations regarding age at which

Conclusion

Women with more complex or severe disability were less likely to be up to date with breast and cervical cancer screening. Although disparities in receipt of mammography were accounted for by demographic, socioeconomic, and insurance variables, this was not the case for Pap testing. Targeted efforts are needed to reduce barriers to breast and cervical cancer screening for women with significant disabilities. These may be especially important for lower income, less educated, minority women living

Acknowledgments

This research was supported in part by grant #90DD0684 from the Administration on Intellectual and Developmental Disabilities and by the Institute on Development & Disability at Oregon Health & Science University. Development of the MEPS analytic dataset used in this study was supported in part by grant #H133A080031 from the National Institute on Disability and Rehabilitation Research, U.S. Department of Education. Both Dr. Horner-Johnson and Mr. Dobbertin had full access to all the data in the

Willi Horner-Johnson is a Research Assistant Professor of Public Health and Preventive Medicine at Oregon Health & Science University in Portland, Oregon.

References (42)

  • M. Chu

    Use of mammography as a cancer screening tool, 2001 (statistical brief #22)

    (2003)
  • M. Chu

    Use of the Pap test as a cancer screening tool – 2001 (statistical brief #26)

    (2003)
  • J.W. Cohen et al.

    The medical expenditure panel survey: A national information resource to support healthcare cost research and inform policy and practice

    Medical Care

    (2009)
  • N. Cook et al.

    Role of patient race/ethnicity, insurance and age on Pap smear compliance across ten community health centers in Florida

    Ethnicity & Disease

    (2010)
  • E. Courtney-Long et al.

    Factors associated with self-reported mammography use for women with and women without a disability

    Journal of Women's Health

    (2011)
  • T.M. Ezzati-Rice et al.

    Sample design of the medical expenditure panel survey household component, 1998-2007 (methodology report #22)

    (2008)
  • S. Ferreyra et al.

    Table manners: A guide to the pelvic examination for disabled women and health care providers

    (2001)
  • A.J. Houtenville et al.

    2012 Annual compendium of disability statistics

    (2012)
  • C.N. Klabunde et al.

    Cancer screening - United States, 2010

    MMWR - Morbidity & Mortality Weekly Report

    (2012)
  • Marr, E. L. (2010). Mammography positioning for women with disabilities. In: Caring for women with disabilities: Learn...
  • S.M. Ornstein et al.

    Computer-generated physician and patient reminders: Tools to improve population adherence to selected preventive services

    Journal of Family Practice

    (1991)
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      Approaches toward and understanding of appropriate care for patients with disabilities varied more widely in non-physician participants. Our work aligns with much of the published literature by demonstrating persistent barriers to equitable care for patients with disabilities across built structures; resource availability; and in the understanding, behaviors, and attitudes that underly the disability cultural competence continuum.1–6,8–10,27,28 We build on this literature with the comprehensive nature of our work involving structural and qualitative evaluation of an entire department.

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    Willi Horner-Johnson is a Research Assistant Professor of Public Health and Preventive Medicine at Oregon Health & Science University in Portland, Oregon.

    Konrad Dobbertin is a Research Assistant in the Institute on Disability and Development at Oregon Health & Science University.

    Elena Andresen is Professor of Epidemiology, Chief of the Disability and Health Research Group, and Director of the Oregon Office on Disability and Health at Oregon Health & Science University in Portland, Oregon.

    Lisa Iezzoni is Professor of Medicine at Harvard Medical School and Director of the Mongan Institute for Health Policy at Massachusetts General Hospital in Boston. Dr. Iezzoni is a member of the Institute of Medicine in the National Academy of Sciences.

    The authors have no financial conflicts of interest to disclose.

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