Today in the U.S., at least 54 million persons live with disabilities, and these numbers will increase substantially in coming decades with the aging "baby boomers." At the other end of the life span, rising numbers of children and young adults are also living with disabilities. Healthy People 2020, as well as research and epidemiological studies, have found that persons with disabilities frequently experience large health care disparities. In particular, evidence documents much lower rates of screening for breast and cervical cancers. Various factors could contribute to these disparities in cancer screening. Nonetheless, little research has systematically explored factors associated with cancer screening disparities for persons with disabilities. The overall purpose of this project is to use data from the National Health Interview Survey (NHIS) from 1998 through 2010 to understand better the patterns, trends, and potential contributors to screening for breast, cervical, and colorectal cancers among persons with disabilities. We plan to build our analyses around the World Health Organization's model of disability. In addition to more global indicators of disabilit, we plan to look specifically at self-reported impairments relating to: vision (blind and low vision;hearing (deaf and hard of hearing);movement difficulties;cognitive difficulties;and mental health concerns. Our major specific aims are to: 1. Compare rates of screening for breast, cervical, and colorectal cancers between persons with and without disabilities, cross-sectionally and over time;2. Identify and compare those factors associated with receipt of breast, cervical, or colorectal cancer screening for persons with and without disabilities, respectively, cross-sectionally and over time;and 3. Identify those factors that explain any observed disparities in breast, cervical, or colorectal cancer screening between persons with and without disabilities, cross-sectionally and over time. NHIS did not ask questions about all three cancer screening services during each year;we must therefore restrict the analyses for each type of screening service to those years where information was collected. We shall consider a variety of independent variables as covariates in multivariable models to predict cancer screening, including: specific types of disabilities;interactions among disability types;demographic characteristics, such as age, sex (colorectal cancer), race, ethnicity, education, household composition, household income, geographic region, and urban-rural residence;comorbid health conditions, such as cardio respiratory diseases and diabetes;health behavior-related attributes, such as body mass index and tobacco use;and health care delivery system considerations, such as having health insurance and a usual source of care. In addition to other statistical methods, we shall explore the factors most associated with identified cancer screening disparities using the Peters-Belson analytical approach.

Public Health Relevance

At least 54 million Americans live with disabilities, and they generally face the same risks of developing cancers as do persons without disabilities - sometimes perhaps even greater risks because of higher rates of smoking, obesity, and physical inactivity. Women with disabilities have much lower rates than do other women of being screened for breast and cervical cancers (mammograms and Pap smears, respectively). The purpose of this project is to use national health survey data across multiple years to explore those factors most associated with disparities in screening for breast, cervical, and colorectal cancers among persons with different types of disabilities.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Health Disparities and Equity Promotion Study Section (HDEP)
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Chollette, Veronica
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Massachusetts General Hospital
United States
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Iezzoni, Lisa I; Kurtz, Stephen G; Rao, Sowmya R (2014) Trends in U.S. adult chronic disability rates over time. Disabil Health J 7:402-12