The socioeconomic gradient in all-cause mortality for women with breast cancer: findings from the 1998 to 2006 National Cancer Data Base with follow-up through 2011
The socioeconomic gradient in all-cause mortality for women with breast cancer: findings from the 1998 to 2006 National Cancer Data Base with follow-up through 2011
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DOI：
10.1016/j.annepidem.2015.02.006
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发表时间：
2015-08-01
影响因子：
5.6
通讯作者：
Yang, Anthony
中科院分区：
文献类型：
--
作者：
Feinglass, Joe;Rydzewski, Nick;Yang, Anthony
目的：分析在控制保险状况、人种和民族、分期、治疗方式以及其他人口统计学和医院特征后，乳腺癌患者的社会经济地位(SES)与全因死亡率之间的关系。方法：对1998-2006年间国家癌症数据库中582,396例确诊为导管原位癌或浸润性(I-IV期)乳腺癌的患者进行了2011年的随访。通过将患者分为六个收入和教育水平的邮政编码类别来衡量SES。结果：最高SES组5年和10年生存率分别为87.8%和71.5%，最低SES组分别为79.5%和61.5%。控制所有协变量后，最高至最低的SES危险比从1.69(95%可信区间：1.64-1.74)降至1.27(95%可信区间：1.24-1.31)。结论：保险状况、种族和诊断阶段的差异是SES差异的重要组成部分，并解释了最初SES生存差异的三分之二。SES的残余效应可能反映了所有美国女性健康的潜在社会决定因素。(C)2015 Elsevier Inc.保留所有权利。
Purpose: To analyze the association between socioeconomic status (SES) and all-cause mortality among women diagnosed with breast cancer before and after controlling for insurance status, race and ethnicity, stage, treatment modalities, and other demographic and hospital characteristics.Methods: Data analyzed included follow-up through 2011 for 582,396 patients diagnosed between 1998 and 2006 with ductal carcinoma in situ or invasive (stage I-IV) breast cancer from the National Cancer Data Base. SES was measured by grouping patients into six income and education-level ZIP code categories. Hierarchical Cox regression models were used to analyze SES survival differences.Results: Five- and 10-year survival probabilities for the highest SES group were 87.8% and 71.5%, versus 79.5% and 61.5% for the lowest SES group. Controlling for all covariates reduced the highest-to-lowest SES hazard ratio from 1.69 (95% confidence interval: 1.64-1.74) to 1.27 (95% confidence interval: 1.24-1.31). Results were virtually identical in models that included comorbidity and invasive cancer patients only.Conclusions: Differences in insurance status, race, and stage at diagnosis are important components of SES disparities and explain about two-thirds of the initial SES survival disparity. The residual SES effect likely mirrors underlying social determinants of health for all American women. (C) 2015 Elsevier Inc. All rights reserved.