title: Screening for cervical cancer in women with disability and multimorbidity: a retrospective cohort study in Ontario, Canada.
abstract: BACKGROUND
  People with disability, multiple chronic conditions or both may experience challenges in accessing primary care. We aimed to determine the association between appropriate cervical cancer screening and level of disability among women eligible for screening in Ontario and the influence of relevant sociodemographic and health-related variables, including level of morbidity (measured by number of chronic conditions), on screening.
  
  
  METHODS
  We used multiple linked databases, including 2 waves of the Canadian Community Health Survey (2005 and 2007/08). Of the 22 824 women included in the study, 7600 reported some level of disability. We used Ontario Health Insurance Plan fee codes to identify appropriate cervical cancer screening.
  
  
  RESULTS
  Compared with women without disability, women with disability were older, less educated, had lower income and had more chronic conditions (36.2% had at least 2 conditions v. 8.4% of women without disability). Women with no disability and no chronic conditions were more frequently screened appropriately than those with severe disability and 2 or more chronic conditions (64.5% v. 39.8%). In multivariable logistic regression analysis, age, rurality, education, marital status and household income were each independently associated with cervical cancer screening. There was a significant interaction between level of morbidity and level of disability. Women with a higher level of disability were less likely to be screened than women with lower level of disability as their level of morbidity increased.
  
  
  CONCLUSIONS
  The rate of screening for cervical cancer is low among women with both disability and multimorbidity. Policymakers should note these results as they work toward improving cancer screening rates for an aging population with complex medical needs.
authors.affiliation: St. Michael's Hospital Department of Family and Community Medicine, University of Toronto, Toronto, Ont. ; Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ont. ; Institute for Clinical Evaluative Sciences, Toronto, Ont.
authors.forename: Aisha
authors.initials: A
authors.lastname: Lofters
authors.affiliation: Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ont.
authors.forename: Sara
authors.initials: S
authors.lastname: Guilcher
authors.affiliation: St. Michael's Hospital Department of Family and Community Medicine, University of Toronto, Toronto, Ont. ; Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ont. ; Institute for Clinical Evaluative Sciences, Toronto, Ont.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Toronto Rehabilitation Institute, Toronto, Ont.
authors.forename: Susan
authors.initials: S
authors.lastname: Jaglal
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ont.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Voth
authors.affiliation: St. Michael's Hospital Department of Family and Community Medicine, University of Toronto, Toronto, Ont. ; Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ont. ; Department of Medicine, University of Toronto, Toronto, Ont.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Bayoumi