Examining Disparities in Cancer Screening for Persons with Disabilities

描述(申请人提供)：今天，在美国，至少有5400万人患有残疾，随着婴儿潮一代的老龄化，这个数字将在未来几十年大幅增加。在寿命的另一端，越来越多的儿童和年轻人也生活在残疾之中。《健康人2020》以及研究和流行病学研究发现，残疾人经常经历巨大的医疗保健差距。特别是，有证据表明，乳腺癌和宫颈癌的筛查率要低得多。多种因素可能会导致癌症筛查中的这些差异。然而，很少有研究系统地探讨与残疾人癌症筛查差异相关的因素。该项目的总体目的是使用 从1998年到2010年全国健康访谈调查(NHIS)的数据，以更好地了解在残疾人中筛查乳腺癌、宫颈癌和结直肠癌的模式、趋势和潜在的贡献者。我们计划围绕世界卫生组织的残疾模型进行分析。除了更多的全球残疾指标外，我们计划具体研究自我报告的与以下方面有关的损害：视力(失明和低视力；听力(失聪和听力障碍)；运动困难；认知困难；以及心理健康问题。我们的主要具体目标是：1.比较残障人士和非残障人士之间乳腺癌、子宫颈癌和结直肠癌的筛查率，横截面和随时间变化；2.确定和比较与接受残障人士和非残障人士乳腺癌、子宫颈癌或结直肠癌筛查相关的因素；以及3.确定那些可以解释在残障人士和非残障人士之间观察到的乳腺癌、子宫颈癌或结直肠癌筛查差异的因素。NHIS在每一年都没有询问所有三种癌症筛查服务的问题；因此，我们必须将每种类型筛查服务的分析限制在收集信息的年份。我们将在多变量模型中考虑各种自变量作为协变量来预测癌症筛查，包括：特定类型的残疾；残疾类型之间的相互作用；人口统计特征，如年龄、性别(结直肠癌)、种族、民族、教育、家庭构成、家庭收入、地理区域和城乡居民；共病的健康状况，如心肺疾病和糖尿病；与健康行为相关的属性，如身体质量指数和吸烟；以及医疗保健提供系统的考虑，如是否有医疗保险和通常的护理来源。除了其他统计方法外，我们还将使用彼得斯-贝尔森分析方法探索与已确定的癌症筛查差异最相关的因素。

DESCRIPTION (provided by applicant): 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.