Influence of socioeconomic factors on survival after breast cancer - A nationwide cohort study of women diagnosed with breast cancer in Denmark 1983-1999
Influence of socioeconomic factors on survival after breast cancer - A nationwide cohort study of women diagnosed with breast cancer in Denmark 1983-1999
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DOI：
10.1002/ijc.22979
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发表时间：
2007-12-01
影响因子：
6.4
通讯作者：
Johansen, Christoffer
中科院分区：
文献类型：
--
作者：
Dalton, Susanne Oksbjerg;Ross, Lone;Johansen, Christoffer
乳腺癌生存率社会不平等的原因还远未确定。我们的研究旨在研究丹麦一系列社会经济因素和共病疾病对乳腺癌手术后生存的重要性，丹麦的医疗保健系统是由税收资助和统一的。在临床数据库中确定了1983-1999年接受基于方案的乳腺癌治疗的所有25，897名丹麦妇女，并从基于人口的登记处获得了关于社会经济变量以及躯体和精神共病疾病的信息。我们使用考克斯比例风险模型来估计社会经济地位和总生存率之间的关系，并进一步分析在竞争风险设置中乳腺癌特异性死亡，将所有其他死亡原因视为竞争风险。受高等教育的妇女死亡的校正危险比（HR）降低（风险比，0.91; 95%置信区间（CI），0.85-0.98），收入较高（风险比，0.93; 95%可信区间，0.87-0.98）和较大住房（风险比，0.90; 95%可信区间，0.85-0.96，对于居住在150平方米以上住房的妇女）。共病疾病的存在增加了HR。收入和共病疾病之间的相互作用导致患有共病疾病的低风险乳腺癌贫困妇女初次手术后10年生存率降低15%（相似于65%）与具有相似乳腺癌预后和共病状况的富裕女性相比（类似于80%）表明，丹麦乳腺癌手术后生存的社会不平等的部分原因在于贫困妇女获得和/或遵守共病条件的管理。(C)2007 Wiley-Liss，Inc.
The reasons for social inequality in breast cancer survival are far from established. Our study aims to study the importance of a range of socioeconomic factors and comorbid disorders on survival after breast cancer surgery in Denmark where the health care system is tax-funded and uniform. All 25,897 Danish women who underwent protocol-based treatment for breast cancer in 1983-1999 were identified in a clinical database and information on socioeconomic variables and both somatic and psychiatric comorbid disorders was obtained from population-based registries. We used Cox proportional hazards models to estimate the association between socioeconomic position and overall survival and further to analyse breast cancer specific deaths in a competing risk set-up regarding all other causes of death as competing risks. The adjusted hazard ratio (HR) for death was reduced in women with higher education (HR, 0.91; 95% confidence interval (CI), 0.85-0.98), with higher income (HR, 0.93; 95% CI, 0.87-0.98) and with larger dwellings (HR, 0.90; 95% CI, 0.85-0.96 for women living in houses larger than 150 m(2)). Presence of comorbid disorders increased the HR. An interaction between income and comorbid disorders resulting in a 15% lower survival 10 year after primary surgery in poor women with low-risk breast cancer having comorbid conditions (similar to 65%) compared to rich women with similar breast cancer prognosis and comorbid conditions (similar to 80%) suggests that part of the explanation for the social inequality in survival after breast cancer surgery in Denmark lies in the access to and/or compliance with management of comorbid conditions in poorer women. (C) 2007 Wiley-Liss, Inc.