Determinants of Mammography in Women With Intellectual Disabilities

Article Figures & Data

Table 1.

Proposed Domains of the Ecologic Model Affecting Breast Cancer Screening for Women with Intellectual Disabilities

Concept	Concept Description	Example of Effect on Breast Cancer Screening	Related Variables of Interest
Intrapersonal	Individual factors or ideas influencing behavior	Extremely anxious about mammogram so does not have one	Psychiatric diagnoses Requires sedation or other accommodations for clinical visits Down syndrome Functional status
Interpersonal	Social supports, family, peer groups influencing behavior	Supportive guardian encourages patient to go and accompanies her	Communication status Whether guardian is assigned Whether subject is receiving other screening/preventive services
Institutional	Rules and policies that may promote or prevent behavior	Residential program provides care coordination by a nurse and encourages cancer screenings	Residential setting Day/work program Care coordination by registered nurse
Community	Social groups/organizations in the community that can be formal or informal	Advocacy organizations for adults with disabilities publishes information encouraging mammography	None in this database
Public policy	Local policies and laws to support healthy behaviors	Publications raise awareness of physicians about preventive services for adults with disabilities	None in this database

Table 2.

Methods and Results of Sensitivity Analyses Performed

Variable of Interest	Methods Used to Perform Sensitivity Analyses	Results
ADLs	Each individual ADL score was compared to the summary score. Two different grouped levels of summary score were tested.	No significant improve in the model
Psychiatric diagnosis	Types of psychiatric diagnoses (eg, anxiety, psychosis) were compared to the number of diagnoses recorded (one, two, three or more vs none).	No significant improve in the model
Age	Categorical groupings in Table 1 were compared with continuous variable versus categorical groupings with the last category of ≥60 years.	No significant improve in the model
24-Hour residential setting	Entire analysis was re-run using only clients from 24-hour residential settings because their representation in the database was relatively complete.	All variables remained in the model except guardian and summary ADL score. Effect sizes were similar but slightly higher for all remaining variables in the model. C statistic = 0.723
Recent influenza vaccination	Characteristics of influenza vaccine were negative; women who did not receive a mammogram were analyzed and compared with women who did receive a mammogram and had influenza.	Less able to communicate (64% vs 79%) More likely to have a guardian (58% vs 46%) Less likely to have one or psychiatric diagnosis (54% vs 62%) More likely to have high ADL need (31% vs 19%) More likely to require sedation (22% vs 15%)

Table 3.

Variables Associated With Screening Mammography in Women With Intellectual Disabilities–Bivariate Analysis

Variables	Patients (N = 2907)	Patients With Mammogram^* (%)	Unadjusted Odds Ratio (95% CI)
Intrapersonal
Age (years)
40–49	1022	51	0.89 (0.75–1.05)
50–59	1119	54	Reference
60–69	617	55	1.04 (0.85–1.27)
70–74	149	46	0.73 (0.52–1.03)
Psychiatric diagnosis
≥1	1785	55	1.44 (1.24–1.67)
≥2	786	57	1.30 (1.10–1.53)
≥3	258	61	1.45 (1.12–1.89)
None			Reference
ADLs (summary score)
0	816	57
1	485	54	Reference
2	377	53
3	408	46	0.78 (0.66–0.91)
4	585	48
Requires sedation for clinical visits
Yes	652	50	0.81 (0.68–0.96)
No	2070	56	Reference
Requires special positioning for exams
Yes	159	48	0.73 (0.53–1.00)
No	2496	56	Reference
Uncooperative or requires limited waiting period
Yes	725	50	0.77 (0.65–0.92)
No	1921	57	Reference
Down syndrome
Yes	383	43	0.64 (0.53–0.80)
No	2524	54	Reference
Family history of breast cancer
Yes	212	67	1.85 (1.37–2.48)
No	2695	52	Reference
Interpersonal
Guardian assigned
Yes	1811	50	0.76 (0.65–0.89)
No	1096	57	Reference
Able to communicate
Yes	1780	57	1.54 (1.32–1.78)
No	1113	47	Reference
System level
Residential setting
24-hour support	1700	56	1.32 (1.14–1.53)
Not 24-hour support	1207	49	Reference
Health coordination by RN
Yes	1525	57	1.40 (1.21–1.63)
No	1382	48	Reference
Colon cancer screening (age ≥50 years)
Yes	761	68	2.18 (1.73–2.73)
No	539	49	Reference
Bone density screening (age ≥50 years)
Yes	943	68	2.46 (1.90–3.17)
No	334	46	Reference
Ever had Pap or GYN exam
Yes	1935	64	3.81 (3.24–4.49)
No	972	31	Reference
Flu vaccine given 2007 or after
Yes	1690	68	4.38 (3.74–5.12)
No	1217	32	Reference

↵* Mammogram occurred between January 1, 2007, and December, 31 2008.
ADL, activity of daily living; RN, registered nurse; GYN, gynecologic; Pap, Papanicolaou smear.

Table 4.

Logistic Regression Showing Adjusted Association With Mammography*

Variable	Adjusted Odds Ratio (95% CI)^†
Guardian assigned
Yes	0.77 (0.61–0.95)
No	Reference
Down syndrome
Yes	0.63 (0.48–0.82)
No	Reference
Able to communicate
Yes	1.44 (1.14–1.81)
No	Reference
Requires special positioning for examinations
Yes	0.65 (0.44–0.95)
No	Reference
Family history of breast cancer
Yes	1.91 (1.35–2.70)
No	Reference
Flu vaccine given 2007 or after
Yes	4.67 (3.84–5.66)
No	Reference
Interaction between uncooperative/ requires limited waiting period at medical exams and health coordination by RN
Health coordination by RN
Uncooperative or requires limited waiting period	0.92 (0.81–1.05)
Cooperative and does not require limited waiting period	Reference
No health coordination by RN
Uncooperative or requires limited waiting period	0.79 (0.71–0.89)
Cooperative and does not require limited waiting period	Reference
Interaction between residential setting and ADL
Receives 24-hour residential support
High ADL score	0.88 (0.78–1.01)
Low ADL score	Reference
Receives less than 24-hour residential support or no support
High ADL score	0.77 (0.68–0.87)
Low ADL score	Reference