Nosek M A, Howland C A
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77046, USA.
Arch Phys Med Rehabil. 1997 Dec;78(12 Suppl 5):S39-44. doi: 10.1016/s0003-9993(97)90220-3.
This article reports findings from the National Study of Women with Physical Disabilities about rates of screening for breast and cervical cancer and factors associated with regular screening in a large sample of women with a variety of physical disabilities and a comparison group of women without disabilities.
Case-comparison study using written survey. Data were analyzed using measures of central tendency, chi 2 analysis, logistic regression, and risk using odds ratios.
General community.
A total of 843 women, 450 with disabilities and 393 of their able-bodied friends, aged 18 to 65, who completed the written questionnaire. The most common primary disability type was spinal cord injury (26%), followed by polio (18%), neuromuscular disorders (12%), cerebral palsy (10%), multiple sclerosis (10%), and joint and connective tissue disorders (8%). Twenty-two percent had severe functional limitations, 52% had moderate disabilities, and 26% had mild disabilities.
Outcomes were measured in terms of frequency of pelvic exams and mammograms.
Women with disabilities tend to be less likely than women without disabilities to receive pelvic exams on a regular basis, and women with more severe functional limitations are significantly less likely to do so. No significant difference was found between women with and without disabilities, regardless of severity of functional limitation, in receiving mammograms within the past 2 years. Perceived control emerged as a significant enhancement factor for mammograms and marginally for pelvic exams. Severity of disability was a significant risk factor for noncompliance with recommended pelvic exams, but not mammograms. Race was a significant risk factor for not receiving pelvic exams, but not mammograms. Household income and age did not reach significance as risk factors in either analysis.
Women with physical disabilities are at a higher risk for delayed diagnosis of breast and cervical cancer, primarily for reasons of environmental, attitudinal, and information barriers. Future research should focus on the subpopulations that were not surveyed adequately in this study, women with disabilities who have low levels of education or income, or who are of minority status.
本文报告了全国身体残疾女性研究的结果，该研究涉及大量患有各种身体残疾的女性以及一组无残疾女性对照组的乳腺癌和宫颈癌筛查率及与定期筛查相关的因素。
采用书面调查的病例对照研究。使用集中趋势测量、卡方分析、逻辑回归以及比值比来分析数据。
一般社区。
共有843名年龄在18至65岁之间的女性，其中450名残疾女性及其393名身体健全的朋友完成了书面问卷。最常见的原发性残疾类型是脊髓损伤（26%），其次是小儿麻痹症（18%）、神经肌肉疾病（12%）、脑瘫（10%）、多发性硬化症（10%）以及关节和结缔组织疾病（8%）。22%的人有严重功能受限，52%的人有中度残疾，26%的人有轻度残疾。
通过盆腔检查和乳房X光检查的频率来衡量结果。
残疾女性比无残疾女性接受定期盆腔检查的可能性更低，功能受限更严重的女性接受定期盆腔检查的可能性显著更低。在过去两年内接受乳房X光检查方面，无论功能受限程度如何，残疾女性和无残疾女性之间均未发现显著差异。自我控制感是乳房X光检查的一个显著促进因素，对盆腔检查的促进作用则稍弱。残疾严重程度是不遵守推荐盆腔检查的一个显著风险因素，但对乳房X光检查并非如此。种族是未接受盆腔检查的一个显著风险因素，但对乳房X光检查并非如此。在两项分析中，家庭收入和年龄作为风险因素均未达到显著水平。
身体残疾女性乳腺癌和宫颈癌延迟诊断的风险更高，主要原因是环境、态度和信息方面的障碍。未来的研究应关注本研究中未得到充分调查的亚人群，即教育程度或收入水平较低、或属于少数族裔的残疾女性。
