Research Paper
Receipt of mammography among women with intellectual disabilities: Medical record data indicate substantial disparities for African American women

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Abstract

Background

Little information exists on the receipt of mammography by African American women with intellectual disabilities. Given the high rates of mortality from breast cancer among African American women and low screening rates among women with intellectual disabilities, it is important to understand the health screening behavior of this population.

Objective

We compared rates of mammography receipt among African American and White women with intellectual disabilities (n = 92) living in community settings in one Southeastern state in the United States.

Method

Data were collected from women's medical records or abstraction forms obtained from medical practices. Multivariate logistic regressions were modeled for receipt of mammography in one year, one of two years, or both study years (2008– 2009). Covariates included the women's age, living arrangement, severity of impairment, and urban/rural residence location.

Results

In 2009, 29% of African American women and 59% of White women in the sample received mammograms. Similar disparities were found for receipt of mammography in either 2008 or 2009 and both 2008 and 2009. These disparities persisted after inclusion of model covariates. White women with intellectual disabilities received mammograms at adjusted rates that were nearly three to five times higher than African American women.

Conclusion

African American women with intellectual disabilities receive mammography at significantly lower rates than White women with intellectual disabilities. Assertive measures to improve the screening rates for African American women with intellectual disabilities are urgently needed.

Section snippets

Methods

The present study analyzed retrospective medical record data obtained as part of a larger project that includes a multisite, randomized controlled trial that is testing an intervention to promote cervical and breast cancer screening among women with intellectual disabilities.22 The study protocol was approved by our university's Institutional Review Board.

Results

Sixty-two different medical practices reported mammography data for the 92 women. Of those sites reporting mammography data, 51% were primary care or family physicians, 20% were internal medicine, and 26% were OB/GYNs. The remainder of the medical data was received from the women's group homes, hospitals, or radiologists. Table 1 presents the unadjusted rates of receipt of mammography for African American and White women (1) in 2009; (2) in 2008 or 2009; and (3) in both 2008 and 2009. In 2009,

Discussion

While previous research has indicated significant health disparities for women with intellectual disabilities,30 little is known about racial differences in health care access among this population. This study described mammography presents new evidence of significantly worse rates of mammography among African American women with intellectual disabilities compared to White women with intellectual disabilities. This marked racial disparity persisted even after controlling for a host of variables

Conclusion

This study offers evidence of racial disparities in the receipt of mammography among African American and White women with intellectual disabilities. Assertive policy measures are needed to improve mammography for African American women with intellectual disabilities.

References (33)

  • S.G. Sullivan et al.

    Breast cancer and the uptake of mammography screening services by women with intellectual disabilities

    Prev Med

    (2003)
  • B.D. Smedley et al.

    Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

    (2002)
  • E.D. Paskett et al.

    Racial differences in knowledge, attitudes, and cancer screening practices among a triracial rural population

    Cancer

    (2004)
  • B. Moy et al.

    Barriers to repeat mammography: cultural perspectives of African-American, Asian, and Hispanic women

    Psycho-Oncology

    (2006)
  • K. Blanchard et al.

    Mammographic screening: patterns of use and estimated impact on breast carcinoma survival

    Cancer

    (2004)
  • Health, United States, 2009: with Special Feature on Medical Technology

    (2010)
  • S.J. Henley et al.

    Surveillance of screening-detected cancers (colon and rectum, breast, and cervix) – United States, 2004–2006

    MMWR Surveill Summ

    (November 26, 2010)
  • Cancer Facts and Figures for African Americans 2011–2012

    (2011)
  • L. Franzini et al.

    Effects of race and socioeconomic status on survival of 1,332 black, Hispanic, and white women with breast cancer

    Ann Surg Oncol

    (1997)
  • S.A. Joslyn et al.

    Racial differences in breast carcinoma survival

    Cancer

    (2000)
  • J.O.L. DeLancey et al.

    Recent trends in Black-White disparities in cancer mortality

    Cancer Epidemiol Biomarkers Prev

    (2008)
  • C. DeSantis et al.

    Breast cancer statistics, 2011

    CA Cancer J Clin

    (2011)
  • K. Patja et al.

    Cancer incidence among people with intellectual disability

    J Intell Disabil Res

    (2001)
  • S.G. Sullivan et al.

    The incidence of cancer in people with intellectual disabilities

    Cancer Causes Control

    (2004)
  • B.S. Hulka et al.

    Breast cancer: hormones and other risk factors

    Maturitas

    (2001)
  • H.M.J. Van Schrojenstein Lantman-de Valk et al.

    Reproductive and physical health

  • Cited by (0)

    Financial disclosure/conflict of interest: The authors declare there are no conflicts of interest. Support for the preparation of this manuscript was provided by the National Institute on Disability and Rehabilitation Research grant #H133G090124; the Lurie Institute for Disability Policy at Brandeis University; and the North Carolina Office of Disability & Health.

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