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J Prev Med Public Health > Volume 43(4); 2010 > Article
Journal of Preventive Medicine and Public Health 2010;43(4): 330-340. doi: https://doi.org/10.3961/jpmph.2010.43.4.330
Association Between Socioeconomic Status and All-Cause Mortality After Breast Cancer Surgery: Nationwide Retrospective Cohort Study.
Mi Jin Park, Woojin Chung, Sunmi Lee, Jong Hyock Park, Hoo Sun Chang
1Graduate School of Public Health, Yonsei University, Korea. weather75@yuhs.ac
2National Cancer Control Research Institute, National Cancer Center, Korea.
3Institute of Health Services Research, Yonsei University, Korea.
4Health Insurance Policy Research Institute, National Health Insurance Corporation, Korea.
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.
Key words: Breast cancer; Cox proportional hazards models; Radical mastectomy; Socioeconomic status; Mortality
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