title: Level of disability, multi-morbidity and breast cancer screening: does severity matter?
abstract: BACKGROUND
  Women with disability may be less likely screened for breast cancer. Research is limited on the extent to which level of disability and multi-morbidity influence screening.
  
  
  METHODS
  Using a retrospective population-based cohort study design, we linked administrative and self-reported survey data to identify screening in Ontario. The cohort was identified using two waves of the Canadian Community Health Survey (2005 and 2007/08). Fee codes were used to identify mammography imaging. Rates were examined over a two-year period and compared across level of disability and multi-morbidity.
  
  
  RESULTS
  Among 10,363 women identified for study inclusion, 4660 reported some level of disability. Women with moderate disability had higher screening rates (71.4%) than women with no disability (62.0%) and women with severe disability (67.9%). We observed an inverse V-shaped relationship between level of disability and screening across all levels of multi-morbidity. In multivariate regression, women with moderate disability had higher odds of being screened compared to women with no disability (OR 1.2 [1.09-1.38]). Women with severe disability had lower odds of being screened compared to women with moderate disability (OR 0.72 [0.63-0.82]) and no disability (OR 0.88 [0.78-0.99]). Women with one chronic condition had higher odds of screening compared to women with no chronic conditions (OR 1.31 [1.17-1.46]).
  
  
  CONCLUSIONS
  Our findings suggest that severe levels of disability and morbidity are associated with low likelihoods of breast cancer screening.
authors: Canadian Population Health Initiative, Canadian Institute for Health Information, Toronto, Canada; Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Electronic address: sara.guilcher@utoronto.ca.
authors: Sara J T
authors: SJ
authors: Guilcher
authors: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; St. Michael's Hospital Department of Family and Community Medicine, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada. Electronic address: aisha.lofters@utoronto.ca.
authors: Aisha
authors: A
authors: Lofters
authors: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; St. Michael's Hospital Department of Family and Community Medicine, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada. Electronic address: glazierr@smh.ca.
authors: Richard H
authors: RH
authors: Glazier
authors: Institute for Clinical Evaluative Sciences, Toronto, Canada; Toronto Rehabilitation Institute-University Health Network, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada; Department of Physical Therapy, University of Toronto, Canada. Electronic address: susan.jaglal@utoronto.ca.
authors: Susan B
authors: SB
authors: Jaglal
authors: Toronto Rehabilitation Institute-University Health Network, Toronto, Canada. Electronic address: Jennifer.voth@ices.on.ca.
authors: Jennifer
authors: J
authors: Voth
authors: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada. Electronic address: ahmed.bayoumi@utoronto.ca.
authors: Ahmed M
authors: AM
authors: Bayoumi
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000517:prevention & control; D002908:Chronic Disease; D015897:Comorbidity; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities; D055088:Early Detection of Cancer; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Chronic disease; Mammography; Prevention & control; Vulnerable populations