摘要：Objective. We sought to evaluate preventive cancer screening compliance among adults with disability in California. Methods. We used data from the 2001 California Health Interview Survey to compare disabled and nondisabled adults for differences in preventive cancer screening behaviors. Compliance rates for cancer screening tests (mammography, Papanicolaou test, prostate-specific antigen, sigmoidoscopy/colonoscopy, and fecal occult blood test) between the 2 subpopulations were evaluated. Results. Women with disabilities were 17% (Papanicolaou tests) and 13% (mammograms) more likely than women without disabilities to report noncompliance with cancer screening guidelines. Interactions between disability and reports of a doctor recommendation on cervical cancer screening were significant; women with disabilities had a lower likelihood of receiving a recommendation. Men with disabilities were 19% less likely than men without disabilities to report a prostate-specific antigen test within the last 3 years. Conclusions. secondary to structural and/or clinical factors underpinning the differences found. Despite publication of the Healthy People 2000 and 2010 National Health Promotion and Disease Prevention Objectives, use and quality of preventive cancer screening services by persons with disabilities remain suboptimal. 1 , 2 Roetzheim and Chirikos 3 reported that women with disabilities are diagnosed with breast cancer at a later stage and have higher mortality. Other researchers have found persistently lower rates of Papanicolaou (Pap) test and mammography use among women with major mobility impairments. 4 – 7 Moreover, these findings remained constant after control for demographic characteristics and health care access. The 2000 US Census study identified nearly 1-in-5 Americans reporting some level of disability and more than 12% reporting a severe disability. 8 This large population is growing because of 3 demographic trends: longer life span, aging of the baby boomers, and the survival of previously fatal conditions because of technological advances in medicine. 9 According to Iezzoni et al., 10 “the life expectancy of persons with disabilities is comparable with that of the general population, and, therefore, routine preventive cancer screening is essential to their quality of care.” Existing health services research, however, has largely ignored this population, 11 and the current health care system may be unprepared to respond to the special needs of this growing and diverse population. To better understand the dynamics of preventive cancer screening 12 – 17 and disability, we used a health services framework 18 to compare self-reported cancer screening behavior among persons with and without the presence of a disability. With cancer screening compliance as an outcome variable, a series of analyses were performed to inform how disability and health care access and utilization measures affect screening behavior using data from the 2001 California Health Interview Survey (CHIS 2001). In addition, we explored how 2 mediating factors—doctor’s recommendation and health promoting behaviors—influence the utilization of cancer screening services.
