Socioeconomic inequalities in breast cancer incidence and mortality in Europe-a systematic review and meta-analysis.
Socioeconomic inequalities in breast cancer incidence and mortality in Europe-a systematic review and meta-analysis.
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DOI：
10.1093/eurpub/ckw070
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发表时间：
2016-10
影响因子：
4.4
通讯作者：
Gerdtham U
中科院分区：
文献类型：
--
作者：
Lundqvist A;Andersson E;Ahlberg I;Nilbert M;Gerdtham U
背景：乳腺癌是欧洲女性癌症的主要原因，据估计超过十分之一的女性受到影响。较高的社会经济地位与较高的发病率和较低的病死率有关，而对死亡率的影响则不明确。方法：我们对欧洲社会经济地位与乳腺癌结果之间的关联研究进行了系统的文献回顾和荟萃分析，重点关注混杂因素的影响。计算总结相对风险（SRR）。结果：系统评价包括 25 篇文章，其中 8 篇研究发病率，10 篇研究病死率，8 篇研究死亡率。荟萃分析显示，社会经济地位较高的女性的发病率显着增加（SRR 1.25、1.17-1.32），病死率显着降低（SRR 0.72、0.63-0.81），死亡率显着增加（SRR 1.16、1.10-1.23）。当包括生殖因素时，与发病率的关联变得不显着。在控制肿瘤特征、治疗因素、合并症和生活方式因素后，病死率仍然很高。在控制生殖因素后，死亡率仍然很高。结论：社会经济地位较高的女性乳腺癌发病率显着较高，这可能与生殖因素、乳房X光检查、激素替代治疗和生活方式因素有关。社会经济地位较高的女性死亡率较低，部分原因可能是肿瘤特征、治疗因素、合并症和生活方式因素的差异。与乳腺癌风险和结果相关的几个因素，例如社会经济地位较低的女性筛查出勤率较低，是旨在减少与社会经济相关的健康结果不平等的政策干预的合适目标。
Background: Breast cancer is the leading cause of female cancer in Europe and is estimated to affect more than one in 10 women. Higher socioeconomic status has been linked to higher incidence but lower case fatality, while the impact on mortality is ambiguous. Methods: We performed a systematic literature review and meta-analysis on studies on association between socioeconomic status and breast cancer outcomes in Europe, with a focus on effects of confounding factors. Summary relative risks (SRRs) were calculated. Results: The systematic review included 25 articles of which 8 studied incidence, 10 case fatality and 8 mortality. The meta-analysis showed a significantly increased incidence (SRR 1.25, 1.17–1.32), a significantly decreased case fatality (SRR 0.72, 0.63–0.81) and a significantly increased mortality (SRR 1.16, 1.10–1.23) for women with higher socioeconomic status. The association for incidence became insignificant when reproductive factors were included. Case fatality remained significant after controlling for tumour characteristics, treatment factors, comorbidity and lifestyle factors. Mortality remained significant after controlling for reproductive factors. Conclusion: Women with higher socioeconomic status show significantly higher breast cancer incidence, which may be explained by reproductive factors, mammography screening, hormone replacement therapy and lifestyle factors. Lower case fatality for women with higher socioeconomic status may be partly explained by differences in tumour characteristics, treatment factors, comorbidity and lifestyle factors. Several factors linked to breast cancer risk and outcome, such as lower screening attendance for women with lower socioeconomic status, are suitable targets for policy intervention aimed at reducing socioeconomic-related inequalities in health outcomes.
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影响因子：
15.8
作者：
Moher D;Liberati A;Tetzlaff J;Altman DG;PRISMA Group
通讯作者：
PRISMA Group
影响因子：
4.4
作者：
Elstad, Jon Ivar;Torstensrud, Rita;Kravdal, Oystein
通讯作者：
Kravdal, Oystein
影响因子：
6.3
作者：
Meijer, Mathias;Bloomfield, Kim;Engholm, Gerda
通讯作者：
Engholm, Gerda
影响因子：
6.4
作者：
Bouchardy, Christine;Verkooijen, Helena M.;Fioretta, Gerald
通讯作者：
Fioretta, Gerald
影响因子：
3.8
作者：
Bastiaannet, E.;de Craen, A. J. M.;Liefers, G. J.
通讯作者：
Liefers, G. J.