Dissertation Abstract

Factors Influencing Mammography Utilization Among Disabled and Nondisabled Women

Breast cancer is the second leading cause of cancer mortality in women in the United States. Because the majority of risk factors for breast cancer are not modifiable, early detection methods such as mammography are essential. However, concern exists for the equitable provision and use of mammography services in the U.S. Mammography is often underutilized by various subpopulations resulting, potentially, in these groups not experiencing the benefits of early detection. A subpopulation that has received little attention in the study of mammography utilization encompasses persons classified as disabled.

The 1998 National Health Interview Survey provided the data for this analysis. A health services utilization model served as the conceptual framework and was adopted to analyze the multiple factors that influence mammography use, including factors such as the environment, population characteristics, health behaviors, and health outcomes. In this study, disability is defined as those women with any self reported limitations in activities of daily living, instrumental activities of daily living, cognition, or work.

Results indicate that the mammography utilization rate for disabled women (n = 1,320) was 42.99%, and significantly lower than the rate of 57.37% for nondisabled women (n = 4,733) (z = 646.83; p = .00). This finding was consistent across most study variables. Binary logistic regression results indicate that women with cognitive limitations were nearly half as likely than nondisabled women to utilize mammography (AOR = 0.66; 95% CI: 0.45, 0.97) after controlling for other factors. In the logistic regression analysis, particular, population characteristics (i.e., age, race/ethnicity, education, and health insurance) and health behaviors (i.e., smoking status, clinical breast examination, and usual source of care) were shown to significantly influence mammography utilization.

Results indicate that inequity in mammography utilization exists because disabled women's utilization rates are lower than the rates for nondisabled women. Because disabled women, especially those cognitively impaired, used mammography at lower rates than nondisabled women, disabled women may not realize the benefits of early detection of breast cancer. Furthermore, they may potentially experience both higher rates of undetected breast cancer and breast cancer mortality.

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