Socioeconomic Status and Survival After an Invasive Breast Cancer Diagnosis
Socioeconomic Status and Survival After an Invasive Breast Cancer Diagnosis
复制标题
DOI：
10.1002/cncr.25589
复制
发表时间：
2011-04-01
期刊：
影响因子：
6.2
通讯作者：
Newcomb, Polly A.
中科院分区：
文献类型：
--
作者：
Sprague, Brian L.;Trentham-Dietz, Amy;Newcomb, Polly A.
背景：生活在贫困率高、教育水平低的地区的女性在乳腺癌诊断后的生存率比生活在社会经济地位（SES）指标高的社区的女性要差。然而，很少有研究考察个人层面的 SES 与乳腺癌生存的关系，或者评估社区层面的 SES 独立于个人层面的 SES 的背景作用。方法：本报告的作者对 1995 年至 2003 年间在威斯康星州被诊断患有乳腺癌的 20 岁至 69 岁女性群体（N = 5820）进行了个人层面和社区层面的 SES 与乳腺癌存活率的关系研究。结果：与大学毕业生相比，高中以上未受过教育的女性死于乳腺癌的可能性高出 1.39 倍（95% 置信区间 [CI]，1.10-1.76）。有家庭收入的女性=贫困线的5倍。调整乳房X光检查筛查的使用、诊断时的疾病阶段和生活方式因素的分析消除了收入差异，但教育差异仍然存在（风险比[HR]，1.27；95% CI，0.99-1.61）。在多水平分析中，即使在调整个人水平 SES 后，低社区教育水平仍与乳腺癌死亡率增加相关（HR，1.57；95% CI，1.09-2.27，>= 20% vs
BACKGROUND: Women who live in geographic areas with high poverty rates and low levels of education experience poorer survival after a breast cancer diagnosis than women who live in communities with indicators of high socioeconomic status (SES). However, very few studies have examined individual-level SES in relation to breast cancer survival or have assessed the contextual role of community-level SES independent of individual-level SES. METHODS: The authors of this report examined both individual-level and community-level SES in relation to breast cancer survival in a population-based cohort of women ages 20 to 69 years who were diagnosed with breast cancer in Wisconsin between 1995 and 2003 (N = 5820). RESULTS: Compared with college graduates, women who had no education beyond high school were 1.39 times more likely (95% confidence interval [CI], 1.10-1.76) to die from breast cancer. Women who had household incomes = 5 times the poverty level. Adjusting the analysis for use of screening mammography, disease stage at diagnosis, and lifestyle factors eliminated the disparity by income, but the disparity by education persisted (hazard ratio [HR], 1.27; 95% CI, 0.99-1.61). In multilevel analyses, low community-level education was associated with increased breast cancer mortality even after adjusting for individual-level SES (HR, 1.57; 95% CI, 1.09-2.27 for >= 20% vs