Breast and cervical cancer screening disparities associated with disability severity.
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.


RESULTS
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.
Institute on Development & Disability, Oregon Health & Science University, Portland, Oregon. Electronic address: hornerjo@ohsu.edu.
Willi
W
Horner-Johnson
Institute on Development & Disability, Oregon Health & Science University, Portland, Oregon.
Konrad
K
Dobbertin
Institute on Development & Disability, Oregon Health & Science University, Portland, Oregon.
Elena M
EM
Andresen
Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts.
Lisa I
LI
Iezzoni
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008327:Mammography / Q000706:statistics & numerical data; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D065006:Papanicolaou Test / Q000706:statistics & numerical data; D010808:Physical Examination; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D014626:Vaginal Smears / Q000706:statistics & numerical data; D016387:Women's Health