Cholesterol testing among men and women with disability: the role of morbidity.
OBJECTIVE
Despite more frequent use of health services by people living with disability, the quality of preventive care received may be suboptimal. In this retrospective cohort study, we used administrative data to examine the relationship between cholesterol testing and levels of disability and morbidity among women and men in Ontario, Canada.


METHODS
We linked multiple provincial-level databases in this study. In stratified analyses for women and men, we used multivariable logistic regression to examine differences in cholesterol testing, and we tested for an interaction effect between disability and morbidity. In a secondary analysis, we tested for a three-way interaction between sex, disability, and morbidity on the entire cohort.


RESULTS
There was an interaction between morbidity and disability for both women and men. Women and men with no chronic conditions appeared to be least likely to be up-to-date on cholesterol testing, and among this group, those with moderate disability were more likely to be up-to-date on cholesterol testing than those with no disability (adjusted odds ratio [AOR] =1.51; 95% confidence interval [CI] 1.20-1.90 for women; AOR =1.16; 95% CI 1.00-1.34 for men). Among women and men who had one chronic condition, having severe disability put them at significant disadvantage versus those with no disability. Only 58.5% of men with no disability and no chronic conditions were up-to-date on cholesterol testing.


CONCLUSIONS
An intermediate level of health care need (reflected in this study as level of disability and level of morbidity) may provide a benefit for cholesterol testing, and conversely, health care needs that are too few or too great may negatively affect testing. Public health and practice-based interventions need to be explored to address these findings.
Institute for Clinical Evaluative Sciences; Department of Family and Community Medicine, St Michael's Hospital, University of Toronto; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital.
Aisha K
AK
Lofters
Institute for Clinical Evaluative Sciences; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
Sara Jt
SJ
Guilcher
Institute for Clinical Evaluative Sciences.
Lauren
L
Webster
Institute for Clinical Evaluative Sciences; Department of Family and Community Medicine, St Michael's Hospital, University of Toronto; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital.
Richard H
RH
Glazier
Institute for Clinical Evaluative Sciences.
Susan B
SB
Jaglal
Institute for Clinical Evaluative Sciences; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital.
Ahmed M
AM
Bayoumi
cholesterol testing; disability; morbidity; preventative care; primary care