Lofters Aisha, Guilcher Sara, Glazier Richard H, Jaglal Susan, Voth Jennifer, Bayoumi Ahmed M
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.
Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ont.
CMAJ Open. 2014 Oct 1;2(4):E240-7. doi: 10.9778/cmajo.20140003. eCollection 2014 Oct.
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.
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.
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.
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.
残疾人士、患有多种慢性病的人或两者兼具的人在获得初级医疗服务方面可能会面临挑战。我们旨在确定安大略省符合筛查条件的女性中，适当的宫颈癌筛查与残疾程度之间的关联，以及相关社会人口学和健康相关变量（包括发病程度，以慢性病数量衡量）对筛查的影响。
我们使用了多个相互关联的数据库，包括两轮加拿大社区健康调查（2005年和2007/08年）。在纳入研究的22824名女性中，7600名报告有一定程度的残疾。我们使用安大略省医疗保险计划费用代码来确定适当的宫颈癌筛查。
与无残疾女性相比，残疾女性年龄更大、受教育程度更低、收入更低且患有更多慢性病（36.2%的人至少患有2种疾病，而无残疾女性为8.4%）。无残疾且无慢性病的女性比重度残疾且患有2种或更多慢性病的女性更频繁地接受适当筛查（64.5%对39.8%）。在多变量逻辑回归分析中，年龄、农村地区、教育程度、婚姻状况和家庭收入均与宫颈癌筛查独立相关。发病程度和残疾程度之间存在显著交互作用。随着发病程度增加，残疾程度较高的女性比残疾程度较低的女性接受筛查的可能性更小。
残疾且患有多种疾病的女性宫颈癌筛查率较低。政策制定者在努力提高有复杂医疗需求的老年人群体的癌症筛查率时应注意这些结果。
