Disparities in Routine Breast Cancer Screening for Medicaid Managed Care Members with a Work-Limiting Disability

Abstract

Objective: Examine disparities in routine mammography for women who qualify for Medicaid, because of a work-limiting disability. Methods: Individual-level data were obtained for women enrolled in Massachusetts Medicaid ManagedCare plans who met the 2007 Healthcare Effectiveness Data and Information Set (HEDIS) criteria for the breast cancer screening measure (n=35,171). Disability status was determined from Medicaid eligibility records. Mammography screening was modeled using multivariate logistic regression. Separate models for women with and without a disability were also estimated.Results: Although unadjusted breast cancer screening rates were roughly equal for women with and without disability, after adjusting for confounders disability status had a significant negative association with screening mammography (OR=0.74; p<0.0001). Living farther from a mammography facility or having a diagnosis of domestic violence reduced the odds of screening for women with disabilities, but not for other women. Having a higher illness burden was more detrimental to screening for women with a disability than for those without. Both groups benefited similarly from the first 26 ambulatory care visits, but the impact of additional visits on screening was much larger among women with disabilities.Conclusion: Nationwide, rates of routine mammography for Medicaid managed care plans averaged below 50% in 2006. Given that a majority of eligible women served by Medicaid have disabilities, and studies have shown that women with disabilities are more likely to be diagnosed with late stage disease, a focus on improving rates of screening for women with disabilities is overdue.

Barriers to, and facilitators of, access to cancer services and experiences of cancer care for adults with a physical disability: A mixed methods systematic review

“…14,15 Within the research literature, a large number of predictors of decreased participation have been identified; for example, increased disability severity has been found to be a predictor of decreased participation for all types of cancer screening. 4,5,9,10,14,[16][17][18][19][20][21][22] For people with breast cancer, other disability related predictors of decreased participation include having major lower limb difficulties, 23 being non-ambulatory, 24 using mobility aids, 25 living farther from facilities that offer mammography 26 or having a relative as the main caregiver as opposed to a spouse/partner caregiver. 27 For women with cervical cancer, other disability related predictors of non-participation include having multiple disabilities, 16 having lower limb difficulties, 23 having a relative caregiver as opposed to a spouse/partner caregiver 27 and requiring caregiving for activities of daily living.…”

A Systematic Review to Evaluate the Barriers to Breast Cancer Screening in Women with Disability

“…The following supporting information can be downloaded at: , Supplementary Table S1: Detailed reasoning for exclusion of articles after full-text screening; Supplementary Table S2: Characteristics of the included studies in the systematic review [ 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 ]; Supplementary Table S3: Quality assessment of included studies; Supplementary Table S4: Barriers to BC screening estimated in the included 53 studies.…”