title: Are women with functional limitations at high risk of underutilization of mammography screening?
abstract: OBJECTIVE
  Women with functional limitations face obstacles in adhering to established mammography guidelines owing to personal factors and barriers within the health care system. Whereas some studies have focused on either physical or cognitive limitations that correlate with lower rates of cancer screening, this study examined multiple functional limitations (physical, psychological, and sociability) and mammography screening.
  
  
  METHODS
  Data from the 2000 National Health Interview Survey were analyzed for 9,505 women aged > or =40 years. We hypothesized that women with functional limitations (physical, psychological, and/or sociability) are less likely to receive screening mammography. Access variables (insurance coverage and usual source of health care) and utilization variables (physician contact and receipt of clinical breast examination) were included. Using multiple logistic regression (MLR), we estimated the relative contribution of functional limitations on mammography use after accounting for sociodemographic characteristics and confounding variables.
  
  
  RESULTS
  An estimated 34.6% of women had physical limitations, 16.1% sociability limitations, and 8.1% psychological limitations. After controlling for all other variables, MLR analysis indicated that women with moderate or severe sociability limitations were less likely than their unimpaired counterparts to utilize mammography (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.48-0.81). Interestingly, women with severe physical limitations were more likely than physically able women to utilize mammography screening (OR, 1.28; 95% CI, 1.07-1.53). Women with no insurance, no usual care, and no doctor's visit within the past year were substantially less likely to use mammography screening.
  
  
  CONCLUSIONS
  Sociability limitations, lack of access to health care, and limited regular checkups played significant roles in underutilization of screening mammography.
authors.affiliation: Department of Epidemiology and Biostatistics, Stempel School of Public Health, Florida International University, Miami, Florida 33199, USA. ahmedn@fiu.edu
authors.forename: Nasar U
authors.initials: NU
authors.lastname: Ahmed
authors.forename: Gary L
authors.initials: GL
authors.lastname: Smith
authors.forename: Gillian
authors.initials: G
authors.lastname: Haber
authors.forename: Michael C
authors.initials: MC
authors.lastname: Belcon
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D016001:Confidence Intervals; D005260:Female; D006304:Health Status; D006801:Humans; D008327:Mammography / Q000523:psychology* / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010379:Peer Group; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D016387:Women's Health