title: Women with Visual Impairment and Insured by Medicaid or Medicare Are Less Likely to Receive Recommended Screening for Breast and Cervical Cancers.
abstract: To investigate whether women with visual impairment (VI) receive mammography and Pap testing to the same extent as women without VI among the low income population or those aged 65+ years.
  
  
  
  We analyzed the 2000-2010 Medicaid and Medicare data for South Carolina women. Women with VI were identified on the basis of a qualifying diagnosis in billing data. We assessed women's adherence (full adherence, partial adherence and no screening) with two United States Preventive Services Task Force (USPSTF) cancer screening recommendations (mammography and Pap testing) throughout the course of the study period. Multinomial models were estimated to describe the association between VI and adherence to the two cancer screening recommendations.
  
  
  
  A total of 1308 women with VI and 2635 women without VI (mammography) and 1247 women with VI and 2483 women without VI (Pap testing) were included in the study. After adjusting for age, number of eligible enrollment years, insurance type (Medicare, Medicaid, or both), urban or rural residence and having a hysterectomy, women with VI were significantly less likely than those without VI to have full adherence to mammography recommendations (adjusted odds ratio, OR, 0.49, 95% confidence interval, CI, 0.40-0.60) and Pap testing recommendations (adjusted OR 0.32, 95% CI 0.27-0.39).
  
  
  
  We used a new approach to investigate adherence to USPSTF recommendations, accounting for both full and partial adherence. This approach identified disparities in mammography and Pap testing for women with VI. The findings of this study should facilitate the development of effective interventions to increase screening among women with VI.
authors.affiliation: a University of South Carolina, Arnold School of Public Health , Department of Epidemiology and Biostatistics , Columbia , SC , USA.
authors.forename: Xinling
authors.initials: X
authors.lastname: Xu
authors.affiliation: b University of Mississippi Medical Center , Department of Preventive Medicine , Jackson , MS , USA.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Mann
authors.affiliation: a University of South Carolina, Arnold School of Public Health , Department of Epidemiology and Biostatistics , Columbia , SC , USA.
authors.forename: Suzanne W
authors.initials: SW
authors.lastname: McDermott
authors.affiliation: c University of Missouri Columbia , School of Medicine, Biostatistics and Research Design Unit , Columbia , MO , USA.
authors.forename: Chelsea B
authors.initials: CB
authors.lastname: Deroche
authors.affiliation: d University of South Carolina , School of Medicine, Department of Family and Preventive Medicine , Columbia , SC , USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Gustafson
authors.affiliation: a University of South Carolina, Arnold School of Public Health , Department of Epidemiology and Biostatistics , Columbia , SC , USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Hardin
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007182:Income; D008327:Mammography / Q000706:statistics & numerical data; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D065006:Papanicolaou Test / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*
keywords: Breast cancer; Pap testing screening; cervical cancer; disparities; mammography; visual impairment