Iezzoni Lisa I, Rao Sowmya R, Agaronnik Nicole D, El-Jawahri Areej
Health Policy Research Center-Mongan Institute, Massachusetts General Hospital.
Department of Medicine, Harvard Medical School.
Med Care. 2021 Feb 1;59(2):139-147. doi: 10.1097/MLR.0000000000001449.
Studies suggest that women with disability experience disparities in routine, high-value screening services, including mammograms and Papanicolaou (Pap) tests. However, few studies have explored whether women with disability have higher risks than other women of developing breast or cervical cancers.
The authors analyzed 2010, 2013, 2015, and 2018 National Health Interview Surveys, which involved civilian, noninstitutionalized US residents, and included supplemental surveys on cancer screening. The authors used self-reported functional status limitations to identify women without disability and women with movement difficulties (MDs) or complex activity limitations (CAL) predating breast or cervical cancer diagnoses. Multivariable models evaluated associations of disability status to cancer diagnosis, adjusting for other variables. Analyses used sampling weights, producing national estimates.
The sample included 66,641 women; 24.4% reported MD and 14.5% reported CAL. Compared with women without disability, women with pre-existing MD or CAL had significantly higher rates of breast cancer (2.2% vs. 3.5% and 3.6%, respectively) and cervical cancer (0.6% vs. 0.8% and 1.0%, respectively). Women with disability had significantly lower recent mammography and Pap test rates than women without disability. After adjusting for all covariates, the values for odds ratio (95% confidence interval) of pre-existing CAL for cancer diagnoses were 1.21 (1.01-1.46; P=0.04) for breast cancer and 1.43 (1.04-1.99; P=0.03) for cervical cancer.
Pre-existing disability is associated with a higher likelihood of breast and cervical cancer diagnoses, raising the urgency of eliminating disability disparities in mammography and Pap testing. Further research will need to explore the causes of these higher cancer rates.
研究表明，残疾女性在常规的高价值筛查服务方面存在差异，包括乳房X光检查和巴氏试验。然而，很少有研究探讨残疾女性患乳腺癌或宫颈癌的风险是否高于其他女性。
作者分析了2010年、2013年、2015年和2018年的全国健康访谈调查，该调查涉及美国平民、非机构化居民，并包括癌症筛查补充调查。作者使用自我报告的功能状态限制来识别无残疾女性以及在乳腺癌或宫颈癌诊断之前就有行动困难（MD）或复杂活动限制（CAL）的女性。多变量模型评估残疾状态与癌症诊断之间的关联，并对其他变量进行调整。分析使用抽样权重，得出全国估计数。
样本包括66641名女性；24.4%报告有行动困难，14.5%报告有复杂活动限制。与无残疾女性相比，先前有行动困难或复杂活动限制的女性患乳腺癌（分别为2.2%对3.5%和3.6%）和宫颈癌（分别为0.6%对0.8%和1.0%）的比率明显更高。残疾女性最近进行乳房X光检查和巴氏试验的比率明显低于无残疾女性。在对所有协变量进行调整后，先前有复杂活动限制的女性患癌症诊断的优势比（95%置信区间），乳腺癌为1.21（1.01 - 1.46；P = 0.04），宫颈癌为1.43（1.04 - 1.99；P = 0.03）。
先前存在的残疾与乳腺癌和宫颈癌诊断的较高可能性相关，这凸显了消除乳房X光检查和巴氏试验中残疾差异的紧迫性。进一步的研究需要探索这些较高癌症发病率的原因。
