title: Trends in mammography over time for women with and without chronic disability.
abstract: BACKGROUND
  Women with disabilities often receive mammograms at lower rates than do nondisabled women, although this disparity varies by disability type and severity. Given the implementation of disability civil rights laws in the early 1990s, we examined whether disability disparities in mammogram use have diminished over time.
  
  
  METHODS
  We analyzed National Health Interview Survey responses of civilian, noninstitutionalized United States female residents 50 to 74 years old from selected years between 1998 and 2010. We identified seven chronic disability types using self-reported functional impairments, activity/participation limitations, and expected duration. We conducted bivariable and multivariable logistic regression analyses examining associations of self-reported mammogram use within the previous two years with sociodemographic factors and disability.
  
  
  RESULTS
  Most chronic disability rates rose over time. The most common disability was movement difficulties, with rates increasing from 35.6% (1998) to 39.8% (2010). Mammogram rates for all women remained relatively stable over time, ranging from 72% to 75%. Bivariable analyses generally found statistically significantly lower mammogram rates for women with disability versus nondisabled women. Over time, disparities grew significantly between women with any basic action difficulty or complex activity limitation and nondisabled women (p<0.01). In multivariable logistic analyses, having any difficulty with basic actions was significantly associated with lower adjusted odds of mammography; for example, adjusted odds [95% confidence interval]=0.5 [0.3-0.8], p=0.006, in the model involving movement disability.
  
  
  CONCLUSIONS
  Little has changed since 1998 in mammogram rates for women with versus without disabilities. Women with certain disabilities continue to experience disparities in mammography testing.
authors.affiliation: 1 Mongan Institute for Health Policy, Massachusetts General Hospital , Boston, Massachusetts.|2 Department of Medicine, Harvard Medical School , Cambridge, Massachusetts.
authors.forename: Lisa I
authors.initials: LI
authors.lastname: Iezzoni
authors.affiliation: 3 Department of Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Kurtz
authors.affiliation: 3 Department of Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts.|4 Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center , Bedford, Massachusetts.
authors.forename: Sowmya R
authors.initials: SR
authors.lastname: Rao
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D006233:Persons with Disabilities; D005260:Female; D006304:Health Status; D006306:Health Surveys; D054625:Healthcare Disparities; D006801:Humans; D007182:Income; D007348:Insurance, Health; D008327:Mammography / Q000706:statistics & numerical data* / Q000639:trends; D008403:Mass Screening / Q000639:trends; D008875:Middle Aged; D012044:Regression Analysis; D012944:Social Support; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology