Sara J T Guilcher1, Aisha Lofters2, Richard H Glazier3, Susan B Jaglal4, Jennifer Voth5, Ahmed M Bayoumi6. 1. 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. 2. 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. 3. 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. 4. 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. 5. Toronto Rehabilitation Institute-University Health Network, Toronto, Canada. Electronic address: Jennifer.voth@ices.on.ca. 6. 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.
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.
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.
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