Health Policy Research Center-Mongan Institute, Massachusetts General Hospital.
Department of Medicine, Harvard Medical School.
J Natl Compr Canc Netw. 2020 Aug;18(8):1031-1044. doi: 10.6004/jnccn.2020.7551.
Approximately 61 million Americans have a disability. Little research has explored whether disability is associated with subsequent diagnosis of cancer, the second-leading cause of death in the United States. The objective of this study was to explore associations between cancer and disability, focusing on 4 cancers that may present with nonspecific symptoms that could be conflated with aspects of disability, thus delaying cancer diagnoses. An analysis of a nationally representative survey using sampling weights to produce national estimates was performed.
Civilian, noninstitutionalized US residents responding to the 2010-2017 National Health Interview Surveys totaling 259,392 Sample Adult Core survey respondents were included. We used self-reported functional status limitations to identify persons with movement difficulties (MD), complex activity limitations (CAL), and no disability. Multivariable regressions predicting cancer diagnosis included sociodemographic characteristics, tobacco use, body mass index, access to care indicators, and disability status.
Persons with preexisting disability had significantly higher rates of cancer (ranging from 0.40 [SE, 0.05] for ovarian to 3.38 [0.14] for prostate) than did those without disability (0.20 [0.02] and 1.26 [0.04] for the same cancers; all P<.0001). Multivariable analyses found strong associations of preexisting MD and CAL with colorectal cancer, with adjusted odds ratios (aORs) of 1.5 (95% CI, 1.2-1.9) and 1.9 (1.5-2.4), respectively. For non-Hodgkin's lymphoma, the aOR for CAL was 1.5 (1.1-2.1). For prostate cancer, aORs for MD were 1.2 (1.0-1.3) and 1.1 (1.0-1.3) for CAL. Using cross-sectional survey data, we could only identify statistical associations, not causality.
Our population-based analyses suggest that persons with disability may constitute a high-risk population, with higher cancer incidence. Optimizing appropriate screening and fully investigating new signs and symptoms are therefore critical for patients with disability.
大约有 6100 万美国人患有残疾。很少有研究探讨残疾是否与美国第二大致死原因——癌症的后续诊断有关。本研究旨在探讨癌症与残疾之间的关系，重点关注 4 种癌症，这些癌症可能表现出非特异性症状，这些症状可能与残疾的某些方面相混淆，从而导致癌症诊断延迟。本研究使用抽样权重对全国代表性调查进行了分析，以生成全国估计值。
本研究纳入了对 2010-2017 年全国健康访谈调查做出回应的、居住在非机构化的美国平民，共计 259392 名样本成人核心调查受访者。我们使用自我报告的功能状态限制来确定有运动困难（MD）、复杂活动限制（CAL）和无残疾的人。使用多变量回归预测癌症诊断，包括社会人口统计学特征、吸烟、体重指数、获得医疗保健的指标以及残疾状况。
患有预先存在的残疾的人患癌症的比率明显更高（卵巢癌为 0.40[标准误，0.05]，前列腺癌为 3.38[0.14]），而无残疾的人则为 0.20[0.02]和 1.26[0.04]（所有癌症的差异均<0.0001）。多变量分析发现，预先存在的 MD 和 CAL 与结直肠癌有很强的关联，校正后的比值比（aOR）分别为 1.5（95%CI，1.2-1.9）和 1.9（1.5-2.4）。对于非霍奇金淋巴瘤，CAL 的 aOR 为 1.5（1.1-2.1）。对于前列腺癌，MD 的 aOR 分别为 1.2（1.0-1.3）和 1.1（1.0-1.3），CAL 的 aOR 为 1.1（1.0-1.3）。由于使用了横断面调查数据，我们只能确定统计学关联，而不是因果关系。
我们的基于人群的分析表明，残疾人群可能构成一个高风险人群，癌症发病率更高。因此，优化适当的筛查并充分调查新的体征和症状对残疾患者至关重要。
