Mobility impairments and use of preventive services in women with multiple sclerosis: observational study

Abstract

). The composition of the cohort changed markedly from 1974 to 1997, with a much greater proportion of survivors in 1997 being in the least deprived fifth than in the most deprived (27% and 14%, respectively, of men and 23% and 17% of women).These effects of deprivation on premature death may not be obvious in tables or histograms.2 Our cohort survival graphs, which can be constructed without complex links between records, clearly show the relation between deprivation and mortality.We thank the General Register Office for providing the mortality and population data and David Murphy of the Information and Statistics Division for his help in the initial analyses.Contributors: JC had the original idea, which he then developed with SC. JC did the analyses. Both authors drafted and wrote the paper. JC is the guarantor for the paper.Competing interests: None declared. Although people with multiple sclerosis may have impaired mobility, their lifespans are similar to age matched population controls. They therefore need standard preventive services to prevent early mortality. We evaluated the relation between mobility and use of preventive services in women with multiple sclerosis. Participants, methods, and resultsIn 1996, we sent questionnaires to 1164 adults with multiple sclerosis who had received outpatient care in 1993 or 1994 from one of three systems of health care (two forms of managed care and fee for service insurance) in two regions of the United States. 2 The overall response rate was 80% (930/1164). We report here survey analyses from the 713 women respondents.We collected self reported rates of cervical smear testing, mammography, and breast examination (if over age 50), blood pressure checks, cholesterol screening, and physician assessment of health habits. We assessed these rates according to the patient's mobility level (fully ambulatory, ambulatory with help, and not ambulatory) and compared them with Healthy People 2000 recommendations. 3 For each preventive service, we used logistic regression to model the relation between that service, mobility, patient demographics, comorbidity, 2 system of health care, indicators for having a primary care physician and a multiple sclerosis physician, and specialty of these physicians.The mean age of the women was 47 years; 86% were white and 40% had a four year college degree. Overall rates for cervical smear tests, breast examinations, and mammography exceeded Healthy People 2000 recommendations, but rates were highest for the ambulatory group and lowest for the non-ambulatory group (P<0.05, table). Cervical smear testing was below Healthy People 2000 goals for the ambulatory with help and non-ambulatory groups. In contrast, rates for general preventive services did not differ by mobility.In the multivariable models, ambulatory patients had 5.32 times the odds of having a cervical smear test, 3.62 times the odds of having a breast examination, and 3.24 times the odds of having mammography relative to non-ambulatory patients (all P < 0.05). Older age was associa...

Disability and receipt of clinical preventive services among women

“…In addition, severity of disability has also been found to affect the receipt of preventive care (Diab & Johnston, 2004). Among women with multiple sclerosis, those with more severe mobility impairment were less likely to receive cancer screening services than those with less impairment (Cheng et al, 2001). In specific subgroups such as American Indians with spinal cord injuries, rates of cholesterol screening were lower compared with those without spinal cord injuries (Krause, Coker, Charlifue, & Whiteneck, 1999).…”

Access to Preventive Health Care in Severely Disabled Women with Multiple Sclerosis

“…The proportion of women with a mammogram during the previous year was 48% (95% CI, 35.4%-60.3%), may not be solely due to lack of physician focus on such services but rather may involve factors of accessibility and physical limitations, such as placing legs in stirrups for cervical smear tests or the need to stand in a radiology suite for mammograms. 2,7 Another study of breast and cervical cancer screening 9 in disabled patients also strongly suggests that accessibility issues play a key role in decreased cervical cancer screening in women with disabilities.…”

“…8 However, access to general preventive services, such as blood pressure and cholesterol testing, did not depend on mobility status. 7 This finding suggests that decreased preventive-care access among disabled women…”

“…1,[3][4][5][6] These barriers to adequate care threaten the health of physically disabled individuals. Several studies 7,8 have found significantly diminished use of Papanicolaou tests and mammography in women who have mobility impairments, even when controlling for demographic factors such as insurance coverage and consistent sources of care. 8 However, access to general preventive services, such as blood pressure and cholesterol testing, did not depend on mobility status.…”

Diabetes care among veteran women with disability

“…Although some studies define disability in terms of functional limitations in activities of daily living (Findley & Sambamoorthi, 2004), presence of a condition such as multiple sclerosis (Cheng et al, 2001), and mobility limitations (Iezzoni, McCarthy, Davis, & Siebens 2000), we have defined disability in terms of eligibility for government health insurance programs. Disability status was measured using VHA enrollment priority groups (VHA, 2006) and Medicare enrollment.…”