Aisha Lofters1, Sara Guilcher2, Richard H Glazier1, Susan Jaglal3, Jennifer Voth4, Ahmed M Bayoumi5. 1. 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. 2. Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ont. 3. Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Toronto Rehabilitation Institute, Toronto, Ont. 4. Institute for Clinical Evaluative Sciences, Toronto, Ont. 5. 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.
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. CONCLUSION: 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.
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. CONCLUSION: 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: Steven S Coughlin; Jessica King; Thomas B Richards; Donatus U Ekwueme Journal: Cancer Epidemiol Biomarkers Prev Date: 2006-11 Impact factor: 4.254
Authors: D M Dryden; L D Saunders; B H Rowe; L A May; N Yiannakoulias; L W Svenson; D P Schopflocher; D C Voaklander Journal: Spinal Cord Date: 2004-09 Impact factor: 2.772
Authors: A K Lofters; M Vahabi; V Prakash; L Banerjee; P Bansal; S Goel; S Dunn Journal: Patient Prefer Adherence Date: 2017-03-08 Impact factor: 2.711
Authors: A K Lofters; A Schuler; M Slater; N N Baxter; N Persaud; A D Pinto; E Kucharski; S Davie; R Nisenbaum; T Kiran Journal: BMC Fam Pract Date: 2017-02-28 Impact factor: 2.497
Authors: Aisha K Lofters; Amy Mark; Monica Taljaard; Michael E Green; Richard H Glazier; Simone Dahrouge Journal: BMC Fam Pract Date: 2018-08-29 Impact factor: 2.497
Authors: Aisha Lofters; Maha Chaudhry; Morgan Slater; Andree Schuler; James Milligan; Joseph Lee; Sara J T Guilcher Journal: J Spinal Cord Med Date: 2018-02-09 Impact factor: 1.985
Authors: Aisha K Lofters; Natalie Alex Baker; Ann Marie Corrado; Andree Schuler; Allison Rau; Nancy N Baxter; Fok-Han Leung; Karen Weyman; Tara Kiran Journal: Prev Med Rep Date: 2021-10-25
Authors: A K Lofters; M A O'Brien; R Sutradhar; A D Pinto; N N Baxter; P Donnelly; R Elliott; R H Glazier; J Huizinga; R Kyle; D M Manca; M A Pietrusiak; L Rabeneck; B Riordan; P Selby; K Sivayoganathan; C Snider; N Sopcak; K Thorpe; J Tinmouth; B Wall; F Zuo; E Grunfeld; L Paszat Journal: BMC Public Health Date: 2021-08-03 Impact factor: 3.295
Authors: Aisha K Lofters; Sara Jt Guilcher; Lauren Webster; Richard H Glazier; Susan B Jaglal; Ahmed M Bayoumi Journal: Clin Epidemiol Date: 2016-09-01 Impact factor: 4.790