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The Effect of Comorbid Illness on Receipt of Cancer Screening by Older People

Authors

  • Mitchell T. Heflin MD, MHSc,

    1. Center for Health Services Research and
    2. Geriatrics Research, Education and Clinical Center, VA Medical Center, Durham, North Carolina; and
    3. Center for the Study of Aging and Human Development and
    4. Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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  • Eugene Z. Oddone MD, MHSc,

    1. Center for Health Services Research and
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  • Carl F. Pieper DrPH,

    1. Center for the Study of Aging and Human Development and
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  • Bruce M. Burchett PhD,

    1. Center for the Study of Aging and Human Development and
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  • Harvey Jay Cohen MD

    1. Geriatrics Research, Education and Clinical Center, VA Medical Center, Durham, North Carolina; and
    2. Center for the Study of Aging and Human Development and
    3. Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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Address correspondence to Mitchell T. Heflin, MD, 2511 Blue Zone, Duke South, Duke University Medical Center, Durham, NC, 27710. E-mail: hefli001@mc.duke.edu

Abstract

OBJECTIVES: To identify associations between the type and number of diagnoses and receipt of screening for breast, cervical, and colorectal cancer by older people.

DESIGN: Sixth annual follow-up of a community-based survey with 4,162 participants aged 65 and older at baseline in 1986.

SETTING: Piedmont area of North Carolina

PARTICIPANTS: Two thousand two hundred twenty-five subjects with a mean age of 79 who responded in 1992.

MEASUREMENTS: Self-reported receipt of clinical breast examination, mammography, Papanicolaou (Pap) smear, and fecal occult blood testing (FOBT) within the 2 years before the survey.

RESULTS: Hip fracture was associated with lower rates of mammography (odds ratio (OR) = 0.53, 95% confidence interval (CI) = 0.32–0.87) and cognitive impairment with lower rates of FOBT (OR = 0.71, 95% CI = 0.54–0.94). Hypertension was associated with higher rates of breast examination (OR = 1.56, 95% CI = 1.18–2.07), Pap smear (OR = 1.41, 95% CI = 1.09–1.83), and FOBT (OR = 1.37, 95% CI = 1.12–1.66) and a trend toward increasing rates of mammography (OR = 1.28, 95% CI = 0.98–1.69). The presence of three or more comorbid conditions was associated with an increased rate of mammography (OR = 1.35, 95% CI = 1.06–1.71), breast examination (OR = 1.46, 95% CI = 1.12–1.89), and Pap smear (OR = 1.31, 95% CI = 1.04–1.65).

CONCLUSIONS: With few exceptions, the presence of comorbid conditions is not associated with a decreased rate of receipt of screening. In fact, hypertension and the presence of a higher number of comorbid conditions are associated with a higher rate of receipt of cancer screening. This finding may be due to an increase in the frequency of office visits increasing the opportunity for cancer screening.

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