Trends in colorectal cancer screening over time for persons with and without chronic disability.

BACKGROUND: Persons with disabilities have often experienced disparities in routine cancer screening. However, with civil rights protections from the 1990 Americans with Disabilities Act, such disparities may diminish over time. OBJECTIVE: To examine whether disability disparities exist for colorectal cancer screening and whether these screening patterns have changed over time. METHODS: We analyzed National Health Interview Survey responses from civilian, non-institutionalized U.S. residents 50-75 years old from selected years between 1998 and 2010. We specified 7 chronic disability indicators using self-reported functional impairments, activity/participation limitations, and expected duration. Separately for women and men, we conducted bivariable and multivariable logistic regression analyses examining associations of self-reported colorectal cancer screening services with sociodemographic factors and disability type. RESULTS: Patterns of chronic disability differed somewhat between women and men; disability rates generally rose over time. For both women and men, colorectal cancer screening rates increased substantially from 1998 through 2010. Over time, relatively few statistically significant differences were reported in colorectal cancer screening rates between nondisabled persons and individuals with various disabilities. In 2010, reported screening rates were generally comparable between nondisabled and disabled persons. In the few statistically significant differences, persons with disabilities almost always reported higher colorectal cancer screening rates than nondisabled individuals. CONCLUSIONS: According to national survey data, reported use of colorectal cancer screening is similar between nondisabled persons and individuals with a variety of different disability types. Despite physical demands of some colorectal cancer screening tests, disparities do not appear between populations with and without disability.

Trends in Pap Testing Over Time for Women With and Without Chronic Disability.

INTRODUCTION: Data from 20 years ago--shortly after passage of the Americans with Disabilities Act--showed that women with significant mobility disability had 40% lower Pap test rates than other women. METHODS: To examine whether disability disparities in Pap test rates have diminished over time, this study analyzed National Health Interview Survey responses from selected years between 1998 and 2010 from women aged 21-65 years without histories of cervical cancer or hysterectomy. Seven chronic disability types were identified using self-reported functional impairments or participation limitations. Self-reported Pap testing within the previous 3 years was studied. Bivariable analyses and multivariable logistic regression analyses controlling for sociodemographic variables were conducted in 2014. RESULTS: Rates of all chronic disability types increased over time. Pap test rates remained relatively constant over time for all women, holding around 84%-87%. Bivariable analyses found statistically significantly lower rates of Pap testing for women with disability compared with nondisabled women. Multivariable analyses failed to find consistent evidence of lower Pap test rates among women across disability types compared with nondisabled women. In 2010, the AOR for reporting Pap testing for women noting the most severe movement difficulty compared with nondisabled women was 0.35 (95% CI=0.15, 0.79). However, the AOR for this disability type varied over time. CONCLUSIONS: Little has changed over time in Pap test rates for all women. Women with certain disabilities continue to experience disparities compared with nondisabled women in receipt of this important screening test.

Trends in mammography over time for women with and without chronic disability.

BACKGROUND: Women with disabilities often receive mammograms at lower rates than do nondisabled women, although this disparity varies by disability type and severity. Given the implementation of disability civil rights laws in the early 1990s, we examined whether disability disparities in mammogram use have diminished over time. METHODS: We analyzed National Health Interview Survey responses of civilian, noninstitutionalized United States female residents 50 to 74 years old from selected years between 1998 and 2010. We identified seven chronic disability types using self-reported functional impairments, activity/participation limitations, and expected duration. We conducted bivariable and multivariable logistic regression analyses examining associations of self-reported mammogram use within the previous two years with sociodemographic factors and disability. RESULTS: Most chronic disability rates rose over time. The most common disability was movement difficulties, with rates increasing from 35.6% (1998) to 39.8% (2010). Mammogram rates for all women remained relatively stable over time, ranging from 72% to 75%. Bivariable analyses generally found statistically significantly lower mammogram rates for women with disability versus nondisabled women. Over time, disparities grew significantly between women with any basic action difficulty or complex activity limitation and nondisabled women (p<0.01). In multivariable logistic analyses, having any difficulty with basic actions was significantly associated with lower adjusted odds of mammography; for example, adjusted odds [95% confidence interval]=0.5 [0.3-0.8], p=0.006, in the model involving movement disability. CONCLUSIONS: Little has changed since 1998 in mammogram rates for women with versus without disabilities. Women with certain disabilities continue to experience disparities in mammography testing.

Development and validation of a disease-specific risk adjustment system using automated clinical data.

OBJECTIVE: To develop and validate a disease-specific automated inpatient mortality risk adjustment system primarily using computerized numerical laboratory data and supplementing them with administrative data. To assess the values of additional manually abstracted data. METHODS: Using 1,271,663 discharges in 2000-2001, we derived 39 disease-specific automated clinical models with demographics, laboratory findings on admission, ICD-9 principal diagnosis subgroups, and secondary diagnosis-based chronic conditions. We then added manually abstracted clinical data to the automated clinical models (manual clinical models). We compared model discrimination, calibration, and relative contribution of each group of variables. We validated these 39 models using 1,178,561 discharges in 2004-2005. RESULTS: The overall mortality was 4.6 percent (n = 58,300) and 4.0 percent (n = 47,279) for derivation and validation cohorts, respectively. Common mortality predictors included age, albumin, blood urea nitrogen or creatinine, arterial pH, white blood counts, glucose, sodium, hemoglobin, and metastatic cancer. The average c-statistic for the automated clinical models was 0.83. Adding manually abstracted variables increased the average c-statistic to 0.85 with better calibration. Laboratory results displayed the highest relative contribution in predicting mortality. CONCLUSIONS: A small number of numerical laboratory results and administrative data provided excellent risk adjustment for inpatient mortality for a wide range of clinical conditions.