Socioeconomic disparities in breast cancer incidence and survival among parous women: findings from a population-based cohort, 1964–2008

BMC Cancer

Research Article

Ronit Calderon-Margalit¹  Orly Manor¹  Yechiel Friedlander¹  Wiessam Abu Ahmad¹  Ora Paltiel²  Mandy Goldberg³  Susan Harlap⁴ 

[1] Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel;Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel;Department of Hematology, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel;Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W. 168th St., 7th floor, 10032, New York, NY, USA;Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel;Department of Psychiatry, New York University School of Medicine, New York, NY, USA;Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA;Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA;

关键词: Breast cancer;    Incidence;    Survival;    Socioeconomic position;    Education;    Occupation;    Disparities;    Inequalities;    Race/ethnicity;    Population-based cohort;   

DOI  :  10.1186/s12885-015-1931-4

 received in 2015-03-30, accepted in 2015-11-13,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundSocioeconomic position (SEP) has been associated with breast cancer incidence and survival. We examined the associations between two socioeconomic indicators and long-term breast cancer incidence and survival in a population-based cohort of parous women.MethodsResidents of Jerusalem who gave birth between 1964–1976 (n = 40,586) were linked to the Israel Cancer Registry and Israel Population Registry to determine breast cancer incidence and vital status through mid-2008. SEP was assessed by husband’s occupation and the woman’s education. We used log ranks tests to compare incidence and survival curves by SEP, and Cox proportional hazard models to adjust for demographic, reproductive and diagnostic factors and assess effect modification by ethnic origin.ResultsIn multivariable models, women of high SEP had a greater risk of breast cancer compared to women of low SEP (Occupation: HR 1.18, 95 % CI 1.03-1.35; Education: HR 1.39, 95 % CI 1.21-1.60) and women of low SEP had a greater risk of mortality after a breast cancer diagnosis (Occupation: HR 1.33, 95 % CI 1.04-1.70; Education: HR 1.37, 95 % CI 1.06-1.76). The association between education and survival was modified by ethnic origin, with a gradient effect observed only among women of European origin. Women of Asian, North African and Israeli origin showed no such trend.ConclusionsSEP was associated with long-term breast cancer incidence and survival among Israeli Jews. Education had a stronger effect on breast cancer outcomes than occupation, suggesting that a behavioral mechanism may underlie disparities. More research is needed to explain the difference in the effect of education on survival among European women compared to women of other ethnicities.

【 授权许可】

CC BY   
© Goldberg et al. 2015