Level of disability, multi-morbidity and breast cancer screening: does severity matter?

Abstract

Women with disability may be less likely screened for breast cancer. Research is limited on the extent to which level of disability and multi-morbidity influence screening. Using a retrospective population-based cohort study design, we linked administrative and self-reported survey data to identify screening in Ontario. The cohort was identified using two waves of the Canadian Community Health Survey (2005 and 2007/08). Fee codes were used to identify mammography imaging. Rates were examined over a two-year period and compared across level of disability and multi-morbidity. Among 10,363 women identified for study inclusion, 4660 reported some level of disability. Women with moderate disability had higher screening rates (71.4%) than women with no disability (62.0%) and women with severe disability (67.9%). We observed an inverse V-shaped relationship between level of disability and screening across all levels of multi-morbidity. In multivariate regression, women with moderate disability had higher odds of being screened compared to women with no disability (OR 1.2 [1.09-1.38]). Women with severe disability had lower odds of being screened compared to women with moderate disability (OR 0.72 [0.63-0.82]) and no disability (OR 0.88 [0.78-0.99]). Women with one chronic condition had higher odds of screening compared to women with no chronic conditions (OR 1.31 [1.17-1.46]). Our findings suggest that severe levels of disability and morbidity are associated with low likelihoods of breast cancer screening.