Of the 3,813 women in the MEPS sample, 835 (23.3%) were disabled. Disabled women were more likely to be African American, older, separated or divorced, and have lower socioeconomic status in terms of education, income level, and health insurance coverage, compared with nondisabled women (data not shown). Twenty-eight percent of disabled women relied on only public insurance for health insurance coverage; 8% were uninsured. Over half of them (54.2%) were unemployed throughout the survey period. The proportion of having PCP as usual source of care was similar between disabled women and others, but an additional 44% disabled women received usual health care from non-PCP health professionals, versus 38% among nondisabled women. Disability was also associated with obesity, worse perceived physical and mental health, and higher rate of chronic diseases such as diabetes, cancer, heart disease, hypertension, asthma, and mental illness.
presents the unadjusted rates of clinical preventive services and the adjusted odds ratios (AOR) of receiving of clinical preventive services by disabled women from separate multiple logistic regressions. For each type of clinical preventive services, significant differences were found by disability status. Disability was significantly associated with lower rates of receipt of mammograms (81% vs 87%; AOR, 0.63; 95% confidence interval [CI], 0.44–0.89) and Pap smears (79% vs 88%; AOR, 0.64; 95% CI, 0.48–0.85). However, disabled women were more likely to receive colorectal screening (41% vs 31%; AOR, 1.37; 95% CI, 1.08–1.73) and influenza immunization (50% versus 39%; AOR, 1.54; 95% CI, 1.16–2.04). No significant association was found between disability status and cholesterol screening.
Receipt of recommended clinical preventive services by type and disability status among women (N = 3,183) Medical Expenditures Panel Survey, 1999–2002
Among disabled women, for each type, we found significant demographic and socioeconomic differences in receipt of clinical preventive services (). Compared with those with private or public insurance, those without health insurance had the lowest rates across all types of clinical preventive services: mammogram (50% versus 73% and 81%); Pap smear (59% versus 72% and 81%); colorectal screening (17% versus 29% and 49%); influenza immunization (26% versus 54% and 52%); and cholesterol screening (71% versus 92% and 95%). Similarly, the rates of clinical preventive services were the lowest among those without a usual source of care than others. However, the group differences were not statistically significant for colorectal screening or influenza immunization.
Sample n and weighted percent of receipt of recommended clinical preventive services among women with disabilities, Medical Expenditure Panel Survey, 1999–2002
These findings persisted when controlling for individual sociodemographic characteristics, access to care and health factors (). Multiple logistic regressions on each type revealed that disabled women with insurance are more likely to receive each type of clinical preventive services compared to those without any health insurance throughout the study period. For example, the AOR for those with public insurance only ranged from 1.94 for Pap smear to as high as 4.47 for cholesterol screening. AORs for private insurance ranged from 2.71 for influenza immunization to 4.83 for cholesterol screening. Disabled women with a usual source of care (PCP or non-PCP), in general, were 4 times more likely than those without usual source of care to receive mammograms, Pap smears, and cholesterol screenings.
Separate multiple logistic regressions on receipt of recommended clinical preventive services by type among women with disabilities Medical Expenditure Panel Survey, 1999–2002
Even after controlling for other factors, racial minorities were still less likely to receive some of the clinical preventive services. African Americans were half as likely as whites to receive influenza immunization (AOR, 0.49; 95% CI, 0.30–0.81 and 62% less likely to receive cholesterol screenings (AOR, 0.28; 95% CI, 0.11–0.67). However, this was not the case with some of the cancer screening services. For example, Latina women were more than twice more likely than whites to receive mammogram (AOR, 2.64; 95% CI, 1.32–5.27) and Pap smear (AOR, 4.56; 95% CI, 1.86–11.18).