J Prev Med Public Health.  2010 Jul;43(4):330-340. 10.3961/jpmph.2010.43.4.330.

Association Between Socioeconomic Status and All-Cause Mortality After Breast Cancer Surgery: Nationwide Retrospective Cohort Study

• Park MJ
• Chung W
• Lee S
• Park JH
• Chang HS

• KMID: 1094110
• DOI: http://doi.org/10.3961/jpmph.2010.43.4.330

Abstract

OBJECTIVES
This study aims to evaluate and explain the socioeconomic inequalities of all-cause mortality after breast cancer surgery in South Korea.
METHODS
This population based study included all 8868 females who underwent radical mastectomy for breast cancer between January 2002 and June 2003. Follow-up for mortality continued from January 2002 to June 2006. The patients were divided into 4 socioeconomic classes according to their socioeconomic status as defined by the National Health Insurance contribution rate. The relationship between socioeconomic status and all-cause mortality after breast cancer surgery was assessed using the Cox proportional hazards model with adjusting for age, the Charlson's index score, emergency hospitalization, the type of hospital and the hospital ownership.
RESULTS
Those in the lowest socioeconomic status group had a significantly higher hazard ratio of 2.09 (95% CI =1.50 - 2.91) compared with those in the highest socioeconomic group after controlling for all the identifiable confounding variables. For all-cause mortality after radical mastectomy, all the other income groups showed significantly higher 3-year mortality rates than did the highest income group.
CONCLUSIONS
The socioeconomic status of breast cancer patients should be considered as an independent prognostic factor that affects all-cause mortality after radical mastectomy, and this is possibly due to a delayed diagnosis, limited access or minimal treatment leading to higher mortality. This study may provide tangible support to intensify surveillance and treatment for breast cancer among low socioeconomic class women.

Keyword

Breast cancer; Cox proportional hazards models; Radical mastectomy; Socioeconomic status; Mortality

MeSH Terms

Adult
Aged
Breast Neoplasms/diagnosis/mortality/*surgery
Cohort Studies
Female
Humans
Mastectomy, Radical/mortality
Middle Aged
*Mortality
Prognosis
Republic of Korea/epidemiology
Retrospective Studies
Risk Factors
Socioeconomic Factors