my personal edition > multiple sclerosis > news


  E-Mail this DGReview to a colleague

DGReview

Prevention Services Lag For American Women Disabled By Multiple Sclerosis

American women who are considerably disabled by multiple sclerosis are less likely to receive appropriate preventive medical care.

"Women with impaired mobility should be considered a vulnerable population for receipt of breast examinations, mammography, and cervical smear tests," declares Dr Eric Cheng and colleagues at the Department of Neurology, University of California, Los Angeles, United States. "Studies are needed to identify factors causing this and to evaluate interventions to reduce the variation across mobility levels."

Clinicians point out that while people with multiple sclerosis may have impaired mobility, their life spans are similar to age matched population controls. This means they need standard preventive services to prevent early mortality.

Dr Cheng and colleagues collected self-reported rates of preventive care, such as cervical smear testing, mammography, blood pressure checks, cholesterol screening, and physician assessment of health habits for 713 women with multiple sclerosis.

In addition, they assessed these rates according to the patient's mobility level --fully ambulatory, ambulatory with help, and not ambulatory-- and compared them with (US) Healthy People 2000 recommendations.

The mean age of the women was 47 years; 86 percent were white and 40 percent had a college degree. Overall rates for cervical smear tests, breast examinations, and mammography exceeded Healthy People 2000 recommendations, but rates were highest for the ambulatory group and lowest for the non-ambulatory group, the clinicians found.

Cervical smear testing was below Healthy People 2000 goals for the ambulatory with help and non-ambulatory groups. In contrast, rates for general preventive services did not differ by mobility.

Dr Cheng, using multivariable models, found that ambulatory patients had 5.32 times the odds of having a cervical smear test, 3.62 times the odds of having a breast examination, and 3.24 times the odds of having mammography relative to non-ambulatory patients.

"Older age was associated with a lower rate of cervical smear tests; however, no other variables were related to receipt of women's preventive services, the clinicians found. Except for an increased odds of assessing eating habits in the non-ambulatory group, mobility status did not affect the odds of receiving general preventive services.

The researchers said that their findings "are the same as those in a previous population based US study of women with and without mobility impairments due to various conditions, even though women in our study had a single chronic condition, were younger, were more educated, and all had health insurance and a regular source of care in health systems that met broad national screening goals."

Clinicians advanced several possible explanations: "Doctors may believe that such patients do not have an adequate life expectancy to warrant women's preventive screening. However, such attitudes would be incompatible with the high rates of blood pressure and cholesterol checks. Alternatively, patients may be reluctant to undergo screening services that are potentially uncomfortable or embarrassing.

"A third possibility is that the medical systems cannot easily accommodate patients with mobility impairments, who may require access to specialized equipment and extra time."
BMJ 2001; 323:968-9. "Mobility impairments and use of preventive services in women with multiple sclerosis: observational study"

E-Mail this DGReview to a colleague

To print, use this version