Abstract
Purpose: To analyze the association between socioeconomic status (SES) and all-cause mortality among women diagnosed with breast cancer before and after controlling for insurance status, race and ethnicity, stage, treatment modalities, and other demographic and hospital characteristics. Methods: Data analyzed included follow-up through 2011 for 582,396 patients diagnosed between 1998 and 2006 with ductal carcinoma in situ or invasive (stage I-IV) breast cancer from the National Cancer Data Base. SES was measured by grouping patients into six income and education-level ZIP code categories. Hierarchical Cox regression models were used to analyze SES survival differences. Results: Five- and 10-year survival probabilities for the highest SES group were 87.8% and 71.5%, versus 79.5% and 61.5% for the lowest SES group. Controlling for all covariates reduced the highest-to-lowest SES hazard ratio from 1.69 (95% confidence interval: 1.64-1.74) to 1.27 (95% confidence interval: 1.24-1.31). Results were virtually identical in models that included comorbidity and invasive cancer patients only. Conclusions: Differences in insurance status, race, and stage at diagnosis are important components of SES disparities and explain about two-thirds of the initial SES survival disparity. The residual SES effect likely mirrors underlying social determinants of health for all American women.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 549-555 |
| Number of pages | 7 |
| Journal | Annals of Epidemiology |
| Volume | 25 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 1 2015 |
| Externally published | Yes |
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Keywords
- Breast cancer epidemiology
- Lack of health insurance
- Racial disparities
- Socioeconomic status
- Stage at diagnosis
ASJC Scopus subject areas
- Epidemiology
Cite this
The socioeconomic gradient in all-cause mortality for women with breast cancer : Findings from the 1998 to 2006 National Cancer Data Base with follow-up through 2011. / Feinglass, Joe; Rydzewski, Nick; Yang, Anthony.
In: Annals of Epidemiology, Vol. 25, No. 8, 01.08.2015, p. 549-555.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The socioeconomic gradient in all-cause mortality for women with breast cancer
T2 - Findings from the 1998 to 2006 National Cancer Data Base with follow-up through 2011
AU - Feinglass, Joe
AU - Rydzewski, Nick
AU - Yang, Anthony
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Purpose: To analyze the association between socioeconomic status (SES) and all-cause mortality among women diagnosed with breast cancer before and after controlling for insurance status, race and ethnicity, stage, treatment modalities, and other demographic and hospital characteristics. Methods: Data analyzed included follow-up through 2011 for 582,396 patients diagnosed between 1998 and 2006 with ductal carcinoma in situ or invasive (stage I-IV) breast cancer from the National Cancer Data Base. SES was measured by grouping patients into six income and education-level ZIP code categories. Hierarchical Cox regression models were used to analyze SES survival differences. Results: Five- and 10-year survival probabilities for the highest SES group were 87.8% and 71.5%, versus 79.5% and 61.5% for the lowest SES group. Controlling for all covariates reduced the highest-to-lowest SES hazard ratio from 1.69 (95% confidence interval: 1.64-1.74) to 1.27 (95% confidence interval: 1.24-1.31). Results were virtually identical in models that included comorbidity and invasive cancer patients only. Conclusions: Differences in insurance status, race, and stage at diagnosis are important components of SES disparities and explain about two-thirds of the initial SES survival disparity. The residual SES effect likely mirrors underlying social determinants of health for all American women.
AB - Purpose: To analyze the association between socioeconomic status (SES) and all-cause mortality among women diagnosed with breast cancer before and after controlling for insurance status, race and ethnicity, stage, treatment modalities, and other demographic and hospital characteristics. Methods: Data analyzed included follow-up through 2011 for 582,396 patients diagnosed between 1998 and 2006 with ductal carcinoma in situ or invasive (stage I-IV) breast cancer from the National Cancer Data Base. SES was measured by grouping patients into six income and education-level ZIP code categories. Hierarchical Cox regression models were used to analyze SES survival differences. Results: Five- and 10-year survival probabilities for the highest SES group were 87.8% and 71.5%, versus 79.5% and 61.5% for the lowest SES group. Controlling for all covariates reduced the highest-to-lowest SES hazard ratio from 1.69 (95% confidence interval: 1.64-1.74) to 1.27 (95% confidence interval: 1.24-1.31). Results were virtually identical in models that included comorbidity and invasive cancer patients only. Conclusions: Differences in insurance status, race, and stage at diagnosis are important components of SES disparities and explain about two-thirds of the initial SES survival disparity. The residual SES effect likely mirrors underlying social determinants of health for all American women.
KW - Breast cancer epidemiology
KW - Lack of health insurance
KW - Racial disparities
KW - Socioeconomic status
KW - Stage at diagnosis
UR - http://www.scopus.com/inward/record.url?scp=84930752412&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84930752412&partnerID=8YFLogxK
U2 - 10.1016/j.annepidem.2015.02.006
DO - 10.1016/j.annepidem.2015.02.006
M3 - Article
C2 - 25795226
AN - SCOPUS:84930752412
VL - 25
SP - 549
EP - 555
JO - Annals of Epidemiology
JF - Annals of Epidemiology
SN - 1047-2797
IS - 8
ER -