Socioeconomic and demographic disparities in breast cancer stage at presentation and survival: A Swiss population-based study.

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State: Public
Version: Author's accepted manuscript
Serval ID
serval:BIB_0AFE12659540
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Socioeconomic and demographic disparities in breast cancer stage at presentation and survival: A Swiss population-based study.
Journal
International journal of cancer
Author(s)
Feller A., Schmidlin K., Bordoni A., Bouchardy C., Bulliard J.L., Camey B., Konzelmann I., Maspoli M., Wanner M., Clough-Gorr K.M.
Working group(s)
SNC and the NICER workinggroup
ISSN
1097-0215 (Electronic)
ISSN-L
0020-7136
Publication state
Published
Issued date
15/10/2017
Peer-reviewed
Oui
Volume
141
Number
8
Pages
1529-1539
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
We explored socioeconomic and demographic disparities in breast cancer (BC) stage at presentation and survival in a Swiss population-based sample of female BC patients linked to the census-based Swiss National Cohort. Tumor stage was classified according to Surveillance, Epidemiology and End Results Program summary stage (in situ/localized/regional/distant). We used highest education level attained to estimate SEP (low/middle/high). Further demographic characteristics of interest were age at presentation (30-49/50-69/70-84 years), living in a canton with organized screening (yes/no), urbanity of residence (urban/peri-urban/rural), civil status (single/married/widowed/divorced) and nationality (Swiss/non-Swiss). We used ordered logistic regression models to analyze factors associated with BC stage at presentation and competing risk regression models for factors associated with survival. Odds of later-stage BC were significantly increased for low SEP women (odds ratio 1.19, 95%CI 1.06-1.34) compared to women of high SEP. Further, women living in a canton without organized screening program, women diagnosed outside the targeted screening age and single/widowed/divorced women were more often diagnosed at later stages. Women of low SEP experienced an increased risk of dying from BC (sub-hazard ratio 1.22, 95%CI 1.05-1.43) compared to women of high SEP. Notably, these survival inequalities could not be explained by socioeconomic differences in stage at presentation and/or other sociodemographic factors. It is concerning that these social gradients have been observed in a country with universal health insurance coverage, high health expenditures and one of the highest life expectancies in the world.

Keywords
breast cancer, health inequalities, incidence, socioeconomic position, survival
Pubmed
Web of science
Create date
06/07/2017 16:30
Last modification date
20/08/2019 12:32
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