Cross-Sectional Analysis of the Associations Between Four Common Cancers and Disability

View More View Less
  • 1 Health Policy Research Center-Mongan Institute, Massachusetts General Hospital;
  • | 2 Department of Medicine, Harvard Medical School;
  • | 3 Massachusetts General Hospital Biostatistics Center; and
  • | 4 Boston University School of Public Health, Boston, Massachusetts.
Restricted access

Background: Approximately 61 million Americans have a disability. Little research has explored whether disability is associated with subsequent diagnosis of cancer, the second-leading cause of death in the United States. The objective of this study was to explore associations between cancer and disability, focusing on 4 cancers that may present with nonspecific symptoms that could be conflated with aspects of disability, thus delaying cancer diagnoses. An analysis of a nationally representative survey using sampling weights to produce national estimates was performed. Methods: Civilian, noninstitutionalized US residents responding to the 2010–2017 National Health Interview Surveys totaling 259,392 Sample Adult Core survey respondents were included. We used self-reported functional status limitations to identify persons with movement difficulties (MD), complex activity limitations (CAL), and no disability. Multivariable regressions predicting cancer diagnosis included sociodemographic characteristics, tobacco use, body mass index, access to care indicators, and disability status. Results: Persons with preexisting disability had significantly higher rates of cancer (ranging from 0.40 [SE, 0.05] for ovarian to 3.38 [0.14] for prostate) than did those without disability (0.20 [0.02] and 1.26 [0.04] for the same cancers; all P<.0001). Multivariable analyses found strong associations of preexisting MD and CAL with colorectal cancer, with adjusted odds ratios (aORs) of 1.5 (95% CI, 1.2–1.9) and 1.9 (1.5–2.4), respectively. For non-Hodgkin’s lymphoma, the aOR for CAL was 1.5 (1.1–2.1). For prostate cancer, aORs for MD were 1.2 (1.0–1.3) and 1.1 (1.0–1.3) for CAL. Using cross-sectional survey data, we could only identify statistical associations, not causality. Conclusions: Our population-based analyses suggest that persons with disability may constitute a high-risk population, with higher cancer incidence. Optimizing appropriate screening and fully investigating new signs and symptoms are therefore critical for patients with disability.

Submitted November 8, 2019; accepted for publication February 18, 2020.

Author contributions: Study concept and design: Iezzoni, El-Jawahri. Principal Investigator: Iezzoni. Literature reviews, data compilation, database management, and analytic programming: Rao, Agaronnik. Statistical analysis: Rao. Analysis and interpretation of results: Iezzoni, Rao, El-Jawahri. Manuscript preparation: Iezzoni, Rao. Critical review: Agaronnik, El-Jawahri.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: The Eunice Kennedy Shriver National Institute of Child Health and Human Development (R21 HD095240-01) funded this work (L.I.I., Principal Investigator; A.E.J., Co-Investigator).

Disclaimer: The funders were not involved in the design, collection, analysis, interpretation of data, or decision to approve publication of finished manuscript.

Correspondence: Lisa I. Iezzoni, MD, MSc, Health Policy Research Center-Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA 02114. Email: liezzoni@mgh.harvard.edu

View associated content

Supplementary Materials

    • Supplemental Materials (PDF 480.33 KB)
  • 1.

    Centers for Disease Control and Prevention. Disability impacts all of us. Accessed October 18, 2019. Available at: https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html

  • 2.

    National Center for Health Statistics. National Health Interview Survey, 2017. Public-use data file and documentation. Accessed July 15, 2020. Available at: https://www.cdc.gov/nchs/nhis/data-questionnaires-documentation.htm

  • 3.

    Heron M. Deaths: leading causes for 2016. Natl Vital Stat Rep 2018;67:177.

  • 4.

    Stout NL, Silver JK, Alfano CM, et al. . Long-term survivorship care after cancer treatment: a new emphasis on the role of rehabilitation services. Phys Ther 2019;99:1013.

    • Search Google Scholar
    • Export Citation
  • 5.

    Sharma R, Molinares-Mejia D, Khanna A, et al. . Training and practice patterns in cancer rehabilitation: a survey of physiatrists specializing in oncology care. PM R 2020;12:180185.

    • Search Google Scholar
    • Export Citation
  • 6.

    Marshall TF, Alfano CM, Sleight AG, et al. . Consensus-building efforts to identify best tools for screening and assessment for supportive services in oncology. Disabil Rehabil 2019;(Fe 19):18.

    • Search Google Scholar
    • Export Citation
  • 7.

    Social Security Administration. All disabled beneficiaries–distribution, by sex and diagnostic group, December 2017. In: Annual Statistical Report on the Social Security Disability Insurance Program; 2018:25. Accessed July 17, 2020. Available at: https://www.ssa.gov/policy/docs/statcomps/di_asr/2017/di_asr17.pdf.

  • 8.

    Social Security Administration. Compassionate allowances. Accessed October 18, 2019. Available at: https://www.ssa.gov/compassionateallowances/

  • 9.

    Centers for Disease Control and Prevention. Cigarette smoking among adults with disabilities. Accessed October 18, 2019. Available at: https://www.cdc.gov/ncbddd/disabilityandhealth/smoking-in-adults.html

  • 10.

    Centers for Disease Control and Prevention. Overweight and obesity–among people with disabilities. Accessed October 18, 2019. Available at: https://www.cdc.gov/ncbddd/disabilityandhealth/documents/obesityFactsheet2010.pdf

  • 11.

    National Cancer Institute. Tobacco. Accessed October 18, 2019. Available at: https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco

  • 12.

    National Cancer Institute. Obesity. Accessed October 18, 2019. Available at: https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity

  • 13.

    National Council on Disability. Highlighting disability/ poverty connection, NCD urges Congress to alter federal policies that disadvantage people with disabilities. Accessed October 18, 2019. Available at: https://ncd.gov/newsroom/2017/disability-poverty-connection-2017-progress-report-release

  • 14.

    Krieger N. Defining and investigating social disparities in cancer: critical issues. Cancer Causes Control 2005;16:514.

  • 15.

    Steele CB, Townsend JS, Courtney-Long EA, et al. . Prevalence of cancer screening among adults with disabilities, United States, 2013. Prev Chronic Dis 2017;14:E09.

    • Search Google Scholar
    • Export Citation
  • 16.

    Andresen EM, Peterson-Besse JJ, Krahn GL, et al. . Pap, mammography, and clinical breast examination screening among women with disabilities: a systematic review. Womens Health Issues 2013;23:e205214.

    • Search Google Scholar
    • Export Citation
  • 17.

    Iezzoni LI, Kurtz SG, Rao SR. Trends in Pap testing over time for women with and without chronic disability. Am J Prev Med 2016;50:210219.

    • Search Google Scholar
    • Export Citation
  • 18.

    Institute of Medicine Committee (IOM), The Future of Disability in America. Washington, DC: National Academies Press; 2007.

  • 19.

    Molton IR, Jensen MP. Aging and disability: biopsychosocial perspectives. Phys Med Rehabil Clin N Am 2010;21:253265.

  • 20.

    LaPlante MP. Key goals and indicators for successful aging of adults with early-onset disability. Disabil Health J 2014;7(1 Suppl)S4450.

    • Search Google Scholar
    • Export Citation
  • 21.

    Bradley CJ, Given CW, Roberts C. Disparities in cancer diagnosis and survival. Cancer 2001;91:178188.

  • 22.

    Mullins MA, Peres LC, Alberg AJ, et al. . Perceived discrimination, trust in physicians, and prolonged symptom duration before ovarian cancer diagnosis in the African American Cancer Epidemiology Study. Cancer 2019;125:44424451.

    • Search Google Scholar
    • Export Citation
  • 23.

    Iezzoni LI. Dangers of diagnostic overshadowing. N Engl J Med 2019;380:20922093.

  • 24.

    National Center for Health Statistics. Survey Description, National Health Interview Survey, 2017. Hyattsville, MD: Centers for Disease Control and Prevention; 2018.

  • 25.

    Kraus L, Lauer E, Coleman R, et al. . 2017 Disability Statistics Annual Report. Durham, NH: University of New Hampshire; 2018.

  • 26.

    National Cancer Institute. Age and cancer risk. Accessed October 18, 2019. Available at: https://www.cancer.gov/about-cancer/causes-prevention/risk/age

  • 27.

    Fleisch Marcus A, Illescas AH, Hohl BC, et al. . Relationships between social isolation, neighborhood poverty, and cancer mortality in a population-based study of US adults. PLoS One 2017;12:e0173370.

    • Search Google Scholar
    • Export Citation
  • 28.

    Bibbins-Domingo K, Grossman DC, Curry SJ, et al. . Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA 2016;315:25642575.

    • Search Google Scholar
    • Export Citation
  • 29.

    Gofine M, Mielenz TJ, Vasan S, et al. . Use of colorectal cancer screening among people with mobility disability. J Clin Gastroenterol 2018;52:789795.

    • Search Google Scholar
    • Export Citation
  • 30.

    Iezzoni LI, Kurtz SG, Rao SR. Trends in colorectal cancer screening over time for persons with and without chronic disability. Disabil Health J 2016;9:498509.

    • Search Google Scholar
    • Export Citation
  • 31.

    Horner-Johnson W, Dobbertin K, Iezzoni LI. Disparities in receipt of breast and cervical cancer screening for rural women age 18 to 64 with disabilities. Womens Health Issues 2015;25:246253.

    • Search Google Scholar
    • Export Citation
  • 32.

    Horner-Johnson W, Dobbertin K, Andresen EM, et al. . Breast and cervical cancer screening disparities associated with disability severity. Womens Health Issues 2014;24:e147153.

    • Search Google Scholar
    • Export Citation
  • 33.

    Jones S, Howard L, Thornicroft G. ‘Diagnostic overshadowing’: worse physical health care for people with mental illness. Acta Psychiatr Scand 2008;118:169171.

    • Search Google Scholar
    • Export Citation
  • 34.

    Foley K-R, Trollor J. Management of mental ill health in people with autism spectrum disorder. Aust Fam Physician 2015;44:784790.

  • 35.

    Kerns CM, Kendall PC, Zickgraf H, et al. . Not to be overshadowed or overlooked: functional impairments associated with comorbid anxiety disorders in youth with ASD. Behav Ther 2015;46:2939.

    • Search Google Scholar
    • Export Citation
  • 36.

    Happell B, Ewart SB, Bocking J, et al. . ‘That red flag on your file’: misinterpreting physical symptoms as mental illness. J Clin Nurs 2016;25:29332942.

    • Search Google Scholar
    • Export Citation
  • 37.

    Shefer G, Henderson C, Howard LM, et al. . Diagnostic overshadowing and other challenges involved in the diagnostic process of patients with mental illness who present in emergency departments with physical symptoms—a qualitative study. PLoS One 2014;9:e111682.

    • Search Google Scholar
    • Export Citation
  • 38.

    Shefer G, Cross S, Howard LM, et al. . Improving the diagnosis of physical illness in patients with mental illness who present in emergency departments: consensus study. J Psychosom Res 2015;78:346351.

    • Search Google Scholar
    • Export Citation
  • 39.

    van Nieuwenhuizen A, Henderson C, Kassam A, et al. . Emergency department staff views and experiences on diagnostic overshadowing related to people with mental illness. Epidemiol Psychiatr Sci 2013;22:255262.

    • Search Google Scholar
    • Export Citation
  • 40.

    SEER*Explorer: an interactive website for SEER cancer statistics. Surveillance Research Program, National Cancer Institute. Accessed October 18, 2019. Available from https://seer.cancer.gov/explorer/

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 2083 856 47
PDF Downloads 493 320 24
EPUB Downloads 0 0 0