Relationships between level of disability and receipt of preventive health services

OBJECTIVES: To examine relationships between level of disability and receipt of certain preventive health services, including demographic and systems variables that may explain or confound these relationships. DESIGN: Analysis of recent (1998 and 2000) data from the Behavioral Risk Factor Surveillance System, a nationwide telephone survey. SETTING: States reporting data on disability (13 in 1998, 18 in 2000). PARTICIPANTS: Noninstitutionalized persons living in the community. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Frequency of receipt of recommended preventive health services, including colorectal, cervical, and breast cancer screening, and influenza and pneumococcal vaccination. An ordinal index of disability severity was constructed from questions on activity limitations. RESULTS: In 2000, people with mild and moderate disability received influenza and pneumonia vaccinations somewhat more frequently than people without disabilities, but people with the most severe disabilities least frequently received vaccinations that year. Disabled women received fewer Papanicolaou tests and clinical breast examinations, but significant differences did not occur for mammograms in 2000. Fewer differences as a function of disability level were apparent in 2000 than 1998. Demographic variables affected receipt of most preventive services. Access to routine checkups affected all preventive services independent of disability level in both years. CONCLUSIONS: Severity of disability is related to receipt of certain preventive services but not necessarily in a simple or unidirectional way. Regardless of disability, receipt of a checkup was an important determinant of receipt of preventive health services. For almost all services and groups studied, preventive care remained below targeted goals for Healthy People 2010.